OPHTE# 1~.-~-~~~► Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 0 6
New Installation ~ Septic Tank)l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION'-TwcEN fZ
Name: (owner) ~1LL GL~2.~G- ~OcnG.S SUBDIVISION VA`SSOMS 0-\.<s LOT # Li I-
System Installer: u5 '~kg-' f t- 5Q-a-4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 'R Public ❑ Well Distance from well ® 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
[00'
Q
2
1
V
C
and all conditions of the improvement rerm¢ ana t.onstrucuon Aumonzatlon.
PERMIT CONDITIONS:
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
If yes, see attached sheet for additional operati n conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
following are the specifications for the sewage disposal system on the a've ca ned property.
Type of system: El Conventional Other C% ~C36cL (Q -fi Septic Tank:'\0130_ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditchhes T of each ditch feet ditches 3 feet ditches a 3~ inches
French Drain Recluiredk~ feet
Authorized State pent ~~~~~9~G&5 Date
1
f
i
F
7,.
saw
.
7 7
t
i
~
~6«.
lh lrj~
/
_
rM
p
(J
WA,
f
r_
Save", `l,S.