OPHTE#Q_ 5-ac1Q3~ Harnett County Department of Public Health 2 0 3 5 3
PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
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Name: (owner) Sco-i-T LV-_E 1 ocY,la..5 \N c SUBDIVISION ~oN tx~Hflti R o~E LOT # 15
System Installer: P o,No-j Registration #
Basement with plumbing: ❑ Garage 'M Number of Bedrooms
Type of Water Supply: ❑ Community X, Public ❑ Well Distance from well ibd feet
System Type: _]CM)p 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.
Ihts 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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i L111 111 wnw I IV113.
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
LIN~s = 1(~~J{v 1 ~~L ~N a 2"1 Q5\ PUMA QLAQ.fr1 S~1L2_~t) Qj~
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Pv ,~Q o GZ Y i- f Septic Tank: i 0 gallons Pump Tank: t004 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches O. of each ditch c() feet ditches feet ditches Q_1A-_-t3 inches
French Drain Required: _ ~ Q> '
Authorized State Agent 65 Date ~ 11 10
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