OPHTE# IO-S~a43~~ Harnett County Department of Public Health
PERMIT # a~ cos Operation Permit 21 6 3 8
New Installation IN Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: NL~-1 W
Name: (owner) C_yrng>F_g, ,,A t~OtnF~ SUBDIVISION T") 1os; !~S~P,NOVA LOT # Y7
System Installer: ~~wrJ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 C~)O 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 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.
`r ~ c~uPPY 4EM~ ~ ` Av'r%PQ
C Larx'4 O fi 5
A
x-15
uq
2
I Z" i
DCOMIT rf111r11T1A
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 cc
IV. Operation:
V. Other
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pr rty.
Type of system: ❑ Conventional X Other S.r1P\,.n BGIL (Q U , C-x Septic Tank: S d o d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc*.r~,_ of each ditch ~ feet ditches 3 feet ditches a~ - 30 inches
French Drain Required: ~~"ice ~Linea~feet
Authorized State Agent ~ \ \ 5 Date G ) a,
~.f
t
I N75
L. ~ g
t vL'..^Wp
§
9
~
a
,
i
X
v
_ t-
KY
a
°
s
4A
gds
IC) -ID- `~L-A 1 1) 0)
~ '44 ' aK