OPHTE# o"~ ~5 -)n 4 1a Harnett County Department of Public Health 2 Q 5 3 5
PERMIT # 'Qx.~`\ 4~ Operation Permit
4 New Installation Septic Tank ❑ RepairA Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 1-A ,o a dA-4 Cu5-racy, 53~,~~p SUBDIVISION LOT # ~-1
System Installer: Air o c t- G2AO 1" a Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tbb feet
System Type: -7T--'~' 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.
nus synem nas oeen mstanea in
wim apph(ahle north larolma beneral Statutes, rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
r iLnru l wnUl l svn).
1. 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. -Sati S~i~owts~o,~ n(>R Fop- Exxc. C~ EH,r= r~ S--oc.PMorLs
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other Mp--~o T-- Septic Tank: 10 o 6 gallons Pump Tank: i00 D gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches 1,1'ag inches
French Drain Requiree~ ar efi
Authorized State Agent n~~ Date
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