OPHTE# cry- s- ) 0)i Harnett County Department of Public Health 21 4 2 5
PERMIT # -rLf 5 Operation Permit
New Installation `K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: W s >_L l_ u c pi-; 9,-V
Name: owner Q N I-'D ( ) SUBDIVISION Gc.'*'.o L.ti r..t p. COc.<,s LOT # 55
System Installer R e~So :-j E-~' Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms --3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: a 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.
Ihrs 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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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ NOA
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
Following are the specifications for the sewage disposal system on the abyve captioned operty.
Type of system: ❑ Conventional X Other C-k1,o,,g~ (C~u~GC \ Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch ~D fapt ditrhnc reef A;f'h.' I?-~~ ;-L-
French-Drain Required: Li feet
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