OPHTE# 3-5 -3a-ii Harnett County Department of Public Health 23061
PERMIT # ` Operation Permit
New Installation �, Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Q -o QSLi-d.1
Name: (owner) C s-,Q o Co e , c�s i ova mac. SUBDIVISION C-D 1-19 3 4p�)"s LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community XPublic ❑ Well Distance from well 1(!)0 feet
System Type: 1 � 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.
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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other PUrnf —Tc� Septic Tank: I t)p C> gallons Pump Tank: I D00 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches - of each ditch 60 feet ditches feet ditches Imo. inches
French Drain Required: ` Linear feet
Authorized State Agent M�, ��`'�. -15 S-,a L. I 2— o 4 cfW ) Date I