OPHTE# )i )i Harnett County Department of Public Health
PERMIT # a 6a'a3 Operation Permit 21 6 3 7
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1"~QCL~S
Name: (owner) 7HN Co Ns~a vc~: 401 SUBDIVISION Ca oPE~I n,M LOT #
System Installer: wo ct r,~ Q w e ) N C- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _IX Type of Water Supply: ❑ Community Public ❑ Well Distance from well lO0 feet
System Type: -0, Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nm system nas oeen mstanea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
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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 conditions, maintenance and reporting.
IV. Operation:
V. Other. Qrc.vs`r~Y Nla~ o S7-~tr. v2 GsNral ~6C1 M,•,NS0 S \ s Y1 P
❑ D-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 -v-- Lp1 Septic Tank: s b O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S 5 feet ditches 3 feet ditches I`Z' 3 inches
French Drain Reauired: _ A I bit
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