OPHTE# 11-57,7-~';'-C Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 6 Q
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M \ca. N ,,gq-0,
Name: (owner) Cumg. u,,,.>,afl No tne_-, SUBDIVISION N,ac, E~s Q~ n.c.,~- LOT #
System Installer: -7e-v TQ>a bw N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well too feet
System Type: 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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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the abo a ca P. ned property.
Type of system: El Conventional Other C~~,P+r1 Septic Tank:
Subsurface No. o exact length width of
Drainage Field ditches t of each ditch 5 feet ditches _
French Drain Required:
H2OLine ❑
PWR Line
®c)o gallons Pump Tank: gallons
depth of
feet ditches at°' inches
Authorized State Agent vw y\ Q-C Date
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