OPHTE# Cf)-sus ) ~ Harnett County Department of Public Health 21 4 5 8
PERMIT Operation Permit
New Installation Septic Tank ❑ Repair Nitrifi cation line El Expansion
PROPERTY LOCATION:
Name: (owner)>Cs~.r~~~t ~Loc~ 5 C, SUBDIVISION C~a2c,~ . 55 ,15 LOT
System Installer: HtOL~ ~2~~L Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community '-ItZ Public ❑ Well Distance from well ADO feet
System Type: --A-7S5 ~ 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.
inu sramu bas ueev Imlanea in compliance wim applicable north tarolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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DCDMIT rnL1111TInuc
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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal3stem on the above captioned property.
Type of system: ❑ Conventional Other 1~2 &y Septic Tank: t00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Reouired` - , J it lt.ut
Authorized State Agent _ ~ Vc)- Date Sd a 1 11 C)
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