OPHTE# Qn -s- sod Harnett County Department of Public Health 21 4 5 7
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion
PROPERTY LOCATION: _ c t t~CStOSta R
Name: (owner) ~ caci~ ~ ds~Cs ~ C, SUBDIVISION CP'ao L- rO ' Spa orbs LOT # _
System Installer T lc~<u L- o Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 O feet
System Type: cr. 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.
n >ptem uas oeen mstanea in
with applicable north Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
' 30
~ F
T
P ~
N
tw
q K
t_ t
C
PERMIT MIJI)1Tltl.
1
t L
q 1
r
1:.3
i
LA
R
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 'rs ca E CH's Septic Tank: t d C 1 C~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f each ditch 5 feet ditches feet ditches_ inches
French Drain Reauired: ti Imo- a~ 4.
Authorized State Agent. :2~\~~~ ~Lo-'5 Date
p
F y~,
M T t ~ Y^
♦1 ~1~
}_6
Him
r^.
ran Map
y x;,
f
°s
y [ ti
Y Y,
tf
L
~ d
44,
L
"
VII 11
A
T
q
w,
vi
4.1.cn'~
r~
~x r may( j
i"
S
~dM
i.1M
f
AM