OPHTE# 10-S-ay>AN(, Harnett County Department of Public Health
PERMIT # a~~a1 \ Operation Permit 21 61 8
New Installation Septic Tank Nitri cation Line El Repair El Expansion
PROPERTY LOCATION: foaa~zosp, \ fz~~V
Name: (owner) C3 V--~ SUBDIVISION Cpao t t r w. SSA o tf LOT # j~>-
System Installer: 0-1- ~5 ; 2~G`~L P.a9 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3_
Type of Water Supply: ❑ CommunityPublic ❑ Well Distance from well 100 feet
System Type: 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 bas 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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DFRMIT rntunlTMUC•
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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.
❑ ID-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~ Z r( Septic Tank: \ o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches 91. 3 0 inches
French Drain Reouired: ~,.o. fob
Authorized State Agent t C-A5 Date °i 1-7 1 ) d