OPHTE# 11 - 5 -HI �&( Harnett County Department of Public Health 24675
PERMIT # yy11 Operation Per t
New Installation ErSeptic Tank B" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: D)e(crct wcr,As 4. UIcS SF s_GGt 5't yrG)f
Name: (owner) Coo ccorl- 14c�nere---,5 i nc_ SUBDIVISION Ox G,'A uJrx'bs LOT # 40
System Installer: R 0 5 I, I : I I.' os Registration # 3 966
Basement with plumbing: ❑ Garage �Neu n
� ber of Bedrooms
Type of Water Supply: ❑ Community GPublic ❑ Well Distance from well / o f feet
System Type: 2 5 % /4 A cJa. cs.� 57 19" 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.
This system has been installed in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
11. 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.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLlne ❑ PWR Line
Following are the specifications for the sewage�sposal system on the above captioned property.
Type of system:
❑ Conventional G? ' Other
0 ✓ GhcwSl c,— �
Septic Tank /000 gallons Pump Tank gallons
Subsurface
No. of
exact length
g �y,ay a$
width of depth of
P
Drainage Field
ditches 3
0( each ditch ' feet
ditches .S feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ✓� Date Jg / 'Oat / a o 1-:3,
Mg