OPHTE# Ir0 X36 Harnett County Department of Public Health 2 0 8 6 4
PERMIT # 2S`~43 Operation Permit
New Installation 1~, Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Go,~Lc--tocx., Lta
Name: (owner) vet Gic72 t : SUBDIVISION ED u M cY+ LOT # 9 L4
System Installer. M s y& S t Pso N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: ~1T c 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.
ihts 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.
II. 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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1 s C-,\ \ Ps Septic Tank: 10
a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of -AWtk Drainage field ditches of each ditch S feet ditches 3 feet ditches inches
French Drain Reouired: fppt
Authorized State Agent y---~ "S Date '-1- 0I 16
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