OPHTE# 0-5----A'~u57 Harnett County Department of Public Health
PERMIT # a 6 1b Operation Permit 21 5 91
New Installation a Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: n kQ:'-5
Name: (owner) 5 \ r- NO.-, ya-C. YV0 mE-5 SUBDIVISION C, ofG( A23n5 LOT #
System Installer: 0-s i5 S-sct.~c~~U~.wt Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms _3
Type of Water Supply: ❑ Community 'R Public ❑ Well Distance from well 1 00 feet
System Type: = a 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.
nas sysrem nas oeen msranea in compoance wim appucaoie norin Lamina jenerai statutes, Wes for xwage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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CS Yc-36,
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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z `F: ^ ,
Subsurface No. of exact length
Drainage field ditches each ditch -10 feet
French Drain Required: O to
ly a
H2OLine ❑
Septic Tank: v n O d gallons Pump Tank: T
width of depth of
ditches 3 feet ditches
PWR Line
gallons
inches
Authorized State Agent N5 - Date $ 116110
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