OPHTE# 11 a0VR9 'I Harnett County Department of Public Health
PERMIT # Operation Permit 22632
New Installation V Septic TankV Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: s
Name: (owner) c. G� -Aber 14 -UG SUBDIVISION 0 ky—"No rr ti LOT # �
System Installer: Ge aS+tS:1 -- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L—d
Type of Water Supply: ❑ Community 0 Public ❑ Well Distance from well 10 0 feet
System Type: =5, 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
�a.
►.a3 -►
co'
>o L)�� 4o
r
A
I
O
YLNMII LUNVIIIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above capt ned property.
Type of system: ❑ Conventional Other, �,�Eiz, � -. Septic Tank: 1000
Subsurface No. of exact length width of
Drainage Field ditches of each ditch feet ditches
French Drain Reauired: n -, S. ® ar feet
Authorized State Agent �� ��� f?-�= � Date
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
a�