OPHTE# 16`5-Harnett County Department of Public Health
PERMIT #Operation Permit 21 8 71
New Installation ~K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
\ PROPERTY LOCATION: QoNooSA R~
Name: (owner) Cun\ bsoat_PNo T-AbMES SUBDIVISION C.A~L\~ S .SoNs LOT #
System Installer: 7-y-o Registration #
Basement with plumbing: ❑ Garage g Number of Bedrooms 3
Type of Water Supply: ❑ Community D. Public ❑ Well Distance from well \00 feet
System Type: 7KZ~":) 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
with applicable North Carolina General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement rermut and lonstruction Authorization.
\ `1
r)_0 b
P~
l I
1t0 V SG
P o co~n~agP, ~ a-P\ L-
PERMIT CONDITIONS:
1. 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:
❑ ID-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned proper
Type of system: ❑ Conventional Other Ptif, P Sa C-P.80-CSeptic Tank: 1000
Subsurface No. of exact length width of
Drainage Field ditches of each ditch l~y feet ditches 3
French Drain Required: ine-feet
H20Line ❑ PWR Line
gallons Pump Tank: BOO IZ) gallons
depth of
feet ditches 1 inches
Authorized State Agent _ ~~~~~V c- 5 Date 1 10 1
l
r
S
~y
Y
^
~
~
{ 3F
w«
~ 1
t
r _
,4, hf! its
P t
~
i
Al
'
-
a R
lR ; . not
z
•
Y
'
I.
Y r t
4+^, .ate" ~ ! % f hits ~ +t",~
~O-S-a~-1®0
t
1~ F
1
a
7