OPHTE# O$'s-a, Harnett County Department of Public Health 19941
PERMIT # aOperation Permit
New Installation Septic Tank ❑ Repairs Nitrification Line ❑ Expansion
PROPERTY LKATION: ~t~ U 1-v~AS P fl CS}s a Ati 1.
Name: (owner) C w a~ t ~s u ca / SUBDIVISION R ca- LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 2)
Type of Water Supply: ❑ Community M. Public ❑ Well Distance from well goo feet
System Type: b 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.
trns system tus oven imtMN in compMance wnh apphc North CzOna General Statutes, Auks for Sewag Treatment and Disposal, and aA ov&om of the
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1. 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 operadan conditions, maintenance and reporting.
IV. Operation:
V. Other.
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: X Conventional ❑ Other Size of tank: Septic Tank: 106 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage field ditches 3 of each ditch feet ditches feet ditrhpt 3!< inrh.c
French Drain Required: ' e t v
Authorized State Agent (t- Date fit'