OPHTE# kN v5 ~-~s l Harnett County Department of Public Health
PERMIT # r'~-C: -7 3 Operation Permit 2 21 0 5
New Installation -~5k Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: ALL l-yc
Name: (owner) C.LP.a..-'L QOM SUBDIVISION LOT # aG
System Installer: z v~ o~vE~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ~
Type of Water Supply: ❑ Community Public ❑ Well Distance from well SQ® 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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1. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. 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:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captio d property.
Type of system: El Conventional Other ( ~Nn'3 Septic Tank: MnC> gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 6 ® feet ditches feet ditches alA33 inches
French Drain Required: Linear feet
Authorized State Agent ~~J ~w~ a-_..\\'~ Date `5
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