OPHTE# {U "5----3SS 7 Harnett County Department of Public Health 21360
PERMIT # Operation Permit
New Installation N Septic Tank ❑ Repair Nitrification line ❑ Expansion
PROPERTY LOCATION: Q5vF5 ~,LoF, Q.z
Name: (owner) ~ycv N Co N~ ;czvc~, a N SUBDIVISION C-P"'S a'ON PN *,ES LOT # 14
System Installer: 2mN-0~ ~~,n Etv Registration #
Basement with plumbing: ❑ Garage W Number of Bedrooms 3
Type of Water Supply: ❑ Community -~K Public ❑ Well Distance from well 100 feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
33,
V3
Q07'
D
R
r
V
ca V a,-
PERMIT CONDITION-
I. Performance:
II. Monitoring.
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No X
If yes, see attached sheet for additional operation conditions, maintenance and reporting,
V. Other. t'ume ,'J b"V L~ ~c S-r 1Lt `'Ca 9G aLCXL~ CO c.K
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other P" --V v ~1wMaG2 yu,c z , ~ Septic Tank: t 0 0 gallons Pump Tank: 1-006 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a of each ditch 1 S feet ditches 3 feet ditches "t"j inches
French Drain Required- Linear feet
Authorized State Agent :N ~ R-Er$ Date
y