OPHTE# Q Harnett County Department of Public Health
PERMIT Operation Permit 219 5 6
I New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 10eser. Name: (owner) G tcassc- ~OQA-, V"-0MC-'60A ~ SUBDIVISION '1C67Sgb 9 Q-D
,,oC- . LOT # 105
System Installer: Cr i ~,5 ^s ct,~ c ~c., Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Community f Public ❑ Well Distance from well ~b® 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.
inis system nas peen mstauea in compuance wan appucame Norm Laroona uenerai matutes, Kiues for sewage treatment and
ry2,~ r
and all conditions of the Improvement Permit and Construction Authorization.
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Zf--N-i-w44 1)SQ8`1 -A
PtKMII CUNUIIIUNS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
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.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional -A Other.-Z-- Septic Tank: I )N04Z) gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch L 1 ® feet ditches feet ditches ty"30
French Drain Required: _ ear fe t.~
PWR Line
gallons
inches
Authorized State Agent ~ ,S ~ Q~T1S Date