OPHTE# 10-5-af--i61 C., Harnett County Department of Public Health
PERMIT #~...r.a C) Operation Permit 21 6 4 9
y New Installation )q Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: n~czo H ~ ~
Name: (owner) Cvn,a Lam, 0 1~oc-, g_s SUBDIVISION ~/oexs>{sa LOT # II
System Installer: T o ~w N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 106 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.
Ihls 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.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NQ,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
❑ D-Box ❑ Pump ❑ Alarm ❑ 1120Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the ab9ve captioned p erty.
Type of system: ❑ Conventio I Other C,rAMaa ~Qv - uc_ 17 Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 1150 feet ditches feet ditches inches
French Drain Reouired _ Linear
Authorized State Agent R-ak~ Date _ 101 It4l10
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