OP REPAIRHTE# REP CC No Harnett County Department of Public Health
PERMIT # a�3�t� Operation Permit 22650
❑ New Installation -0 Septic Tank "� Nitrification Line X JRepair ❑ Expansion
PROPERTY LOCATION: � X15 C' NVN"E. "5 V'1 tiLt_ 1 d "y Fzc�
Name: (owner) _ C�s ssotzP\-� �odn -G SUBDIVISION LOT #
System Installer: 9.,c.<.-I \--�oL- i -tr. ,A -o Registration #
Basement with plumbing: ❑ Garage ❑ Humber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well I dQ feet
System Type: "tTL 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.
tins system_ nas_ peen instan in in compuance vnm appucame norm urotma uenerai statutes, huies mr sewage treatment ana msposai, ana an conditions of the improvement Permit and construction Authorization.
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1. Performance. System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .196E
Ill, 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:
Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-3ne ❑ PAIR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X( Other E Z V%. -O*v Septic Tank: gallons Pump Tank gallons
Subsurface 'No, of exact length width of depth of
Drainage Field ditches of each ditch S feet ditches 3 feet ditches 1� inches
French Drain Reouired: a Let
Authorized State pent_ ' \ CL—})5 Date