OPHTE# 0n-'5-ao'=[ Harnett County Department of Public Health 21 4 61
PERMIT # 25cia.~} Operation Permit
New Installation
Septic Tank El Repair Nitrification Line El Expansion
PROPERTY LOCATION: Ca EVCsylt~6 G-N'S C'A1 fz~
Name: (owner) SS `n opC~~S SUBDIVISION JP+yL~,J Qc,~,S LOT # °I
System Installer. 1 ~ocl. ONS t_v M8% N Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type:b 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.
This 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 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 ❑ Nox
If yes, see attached sheet for additional operation 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: ❑ Conventional Other P v to p O Z 4;Zw Septic Tank: 1 O O n gallons Pump Tank: O gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of~f each ditch 25 a feet ditches 3 feet ditches inches
French Drain Reauired: naxc fnot\
Authorized State Agent_ qz5 Date 51Z-41 IG
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