OPHTE #'3- 53ro�`� Harnett County Department of Public Health
PERMIT # Operation Permit 22840
New Installation Septic Tank l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: At —gAtA . 'D,1 1yC
Name: (owner) CPN aG.S v)L -Q)N G IN SUBDIVISION Zs-T LcaN�1>yQCM-,- 5vr,,fli) OT #
System Installer: !csc>-, E G P,cl.t-4 EQZ Registration #
Basement with plumbing: ❑ Garage -1 Number of Bedrooms T�
Type of Water Supply: ❑ Community >� Public ❑ Well Distance from well 1 b O 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.
This 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
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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: 5yg >z-cw Or�`Ta 1�ANRL L`
E,Nta
ON
5*,VSE
❑ D -Box ❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above a tion roperty.
Type of system: ❑ Conventional Other C.�aA� �
Septic Tank:
►D5b
gallons Pump Tank: gallons
Subsurface No. of exact length
- - -- WA
width of
depth of
3C— ff
Drainage Field itc e --._ of each ditch feet
ditches
feet ditches inches
French Drain Reaufr.
Authorized State Agent �J \� ���� � S Date -711
13- 5- 310-1 �