OPHTE# 11- 5-as'A a,) Harnett County Department of Public Health
PERMIT # a6 ss Operation Permit 21 9 6 3
New Installation 'K Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) CorY,aec&Ly-,.4Q VN ®c-r--5
System Installer: i so R>ag--.r a
Basement with plumbing: ❑ Garage )i~ Number of Bedrooms
Type of Water Supply: ❑ Community ':K Public ❑ Well
System Type: r.
(In accordance with Table V a)
PROPERTY LOCATION: 1" \,,cx; o 1(5wGsz_
SUBDIVISION t,r3r6.,v 9,'P' _r_ LOT # DY
3 Registration #
Distance from well ► OO feet
Types V and VI Systems expire in 5 years.
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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the above caps ned property.
Type of system: ❑ Conventional Other C-~ (Q! Septic Tank: S Ob gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch V~0 feet ditches feet ditches
French Drain Required:t mar feet
PWR Line
gallons
inches
Authorized State Agent s - Date 51)-% I )