OPHTE# QCA-s-a344Lj Harnett County Department of Public Health 21 4 7 7
PERMIT # aS'S 6 Operation Permit
New Installation X Se tic Tank ❑ Repair lx Nitrification Line ❑ Expansion
PROPERTY LOCATION: ,'000- o'5P, V-D
Name: (owner) Cv+~ -o~r.19 t-soln(~~~lL SUBDIVISION Q-Pgox-\r-,P. ~cst~NS LOT # 5-1_
System Installer: TF a T~cLo-,4 N Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms 3_
Type of Water Supply: ❑ Community '~K Public ❑ Well Distance from well 4 feet
System Type: b 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.
ims 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.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No/'Fl,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. 5,tc2A7--PGE ~+.C-ct fl•~Gcsr~r, ~arsr•. has..~,~,n_ Pty
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Following are the specifications for the sewage dispos system on the above captioned property.
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Authorized State Agent C~ 5 Date 6 1 c 1 m
Type of system: El Conventional Other U o Septic Tank: 1D4d gallons Pump Tank, ~OOV gallons
depth No. of exact length r width of 3 epth of
Drainage Field r - AitE1}e of each ditch feet ditches feet inches
ditches 1
French Drain Re wired: ' e NQS