OPHTE# 10 -s--~~ i Harnett County Department of Public Health 21 4 8 3
PERMIT # Operation Permit
j New Installation Septic Tank ❑ Repair tX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Po~vsx~~ o.
Name: (owner) CvMe-S a-x.-r-4D a N~ SUBDIVISION CPQ-0L-"NA .Ax„15 LOT # GZ
System Installer: 1Go g~~+tJ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well LO O feet
System Type: ~;;K~ 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.
Ibis 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.
i
to ~
( G0.Jlq TL
~OND$tZOSR~p,~ ~
DWMIT rnlln!TIAU
1. 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 ❑ NOO1`
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 above captioned I~erty.
Type of system: ❑ Conventional Other ChAC --%c~r~~Qv Septic Tank: t O O O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch l ~a feet ditches 3 feet ditches aZ1-36 inches
french Drain Required: Linear et
Authorized State Agent a~s~~~v~ri~o~~cS Date LO