OPHTE# O°S-s-033-Y~, Harnett County Department of Public Health 21 4 3 0
PERMIT # aS 7 T) Operation Permit
New Installation X Se tic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: VaLaca.o-gyp,
Name: (owner) C j-e>E& -P,-o \koe-(--s ~N L SUBDIVISION Canol.) cJeA~ot~S LOT #
System Installer. 1 [_o ~wN Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms I
Type of Water Supply: ❑ Community ;K, Public ❑ Well Distance from well l 00 feet
System Type: t~ 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.
rms system has been installed in compliance with applicable North Carolina General Statutes, Roles for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
101
4
> /
0
+U
i
2 fi
' 40
v
G
PERMIT rnunlTlnuc•
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the abov captioned prW~erty.
Type of system: ❑ Conventional X Other Otis y.~0 F~ s c-,1--Septic Tank: l d 6 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 50 feet ditches ~ feet ditches a~ inches
French Drain Reauired: fpot
Authorized State Agent r. 5 Date 513110
hen
"w
y€
or
mvi
r-
s
,
46
O C~ - s -a3
3~2
*
g' ff
nor
A
p,