OP RHTE# ac~Harnett County Department of Public Health 2 0 7 7 4
PERMIT # asl`~~ Operation Permit
New Installation '1K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
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Name: (owner) GH,oo C-~to0V\0MES SUBDIVISION LOT #
System Installer. GE2A1-o 1'I- r,QLE Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well \Oo 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.
Ihis 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
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E-Z F't...o Septic Tank `BOO gallons Pump Tank: V50 O gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 4'bQAOu:5 feet ditches 3 feet ditches 1 Z_ inches
French Drain Required: brear feet
Authorized State Agent N, _ Date 5
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