OPHTE # QS - s- ~ T3a~ Harnett County Department of Public Health 19936
PERMIT # t t5~~ Operation Permit
'ilw-htStaNativn Septic Tank ❑ Repair Nitrifiation Line Expansion
PROPERTY LKATION:
Name: (owner) ct cJ~H`i '_~)tA rk ~ C2.. (Cec SUBDIVISION LOT #
System Installer.„ S H -,QP E Registration #
Basement with plumbing ❑ 4®e--~ Number of Bedrooms 3
Type of Water Supply: O Community $ Public ❑ Well Distance from well t 00 feet
System Type: _ ~I a Types Y and VI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
tens s teen has been mstakd in com ancc with appliUbk Naafi farotina Gen" Stuutes K* Im Sewage Treatment ad NPOW, and al cord h m al the kn o+ement P"t and commKhon W m a ion.
SS ~
~6v,~~vG OW~sa+ I
1
1..~ .IE 5
Ex,~stvc
5 e,EOQ,pg7,v~
Flo 115E
W Nve.~s ;\d N +~L
V
QbPASQ `
P gyp. 1
N u C7S61LY 2,p
PFRHrr rnNnMAN(.
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 X
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other.
Following are the specifications for the sewage disposal system on the above captioned property. 10 0 0 E-, I ~t
Type of system: ❑ Conventional 15~ Other i x~p_ C,.s , es Size of tank: Septic Tank: loco .,,E 4 gallons Pump Tank: gallons
Subsurface No. Of A &X,~ c exact length width of depth of
Drainage field itches ate. N of each ditch _R_ feet ditches 3 feet ditches a~► inches
French Drain Required: Unear feet
Authorized State Agent R~~ Date a