OPHTE #_ «-5,% 15'1 Harnett County Department of Public Health 25023
PERMIT # a`16�i Operation Permit
New Installation _> Se tic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATION: k
Name: (owner) Cy an%CaLAe at) ��v M G5 I -4 c- SUBDIVISION Ca6tA3 LOT #
System Installer. ILD e:saow N Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ;K Public ❑ Well Distance from well feet
System Type: 77 L' cam. 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.
In1s system naa dean 1nfO@d In wrionana win appinaiP mom Lamina Uenend atawtel, dmnf for mwaoe Ifemment and pnadsal, and all condlUoni of Ide Imdroveldeol remal and
s�1 II �—E.rx r
Lo
Ho05L
D
yN
t'
5a2 i�a6 r-t,ow G0.a ,�t1..
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ H2OLine ❑ PAIR line
following are the specifications for the sewage disposal tem on the above'ft agtioned�roperty.
Type of system: onventional Other awi!hrwueJZ W� Septic Tank: 1060 gallons Pump Tank: gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch 'aO feet ditches _� feet ditches R-31 inches
French Drain Required feet
Authorized State Agent_ Fai Date
17 - S- L)15--? �