OP RHTE# O1-s-1UC0Q, Harnett County Department of Public Health 21 4 5 5
PERMIT # a.zl3aa Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
_ PROPERTY LOCATION:'~SP+MGs V)Q .aLN5 %P
Name: (owner) F„ G.ti.oPCQ-6 tN c. SUBDIVISION ~'%L-, ; v r"N 'Qo\ roc LOT # a9
System Installer. rTIK.--•c- - &to ~ Registration #
Basement with plumbing: ❑ Garage ~K Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1CD'O 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 Lill III LVI\VIIIV IIJ.
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 disposalsystem on the above captioned property.
Type of system: ❑ Conventional ~I Other (u m P~ EZ, Leo -v Septic Tank: t4 gallons Pump Tank: I O d~ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditcbgs f each ditch feet ditches 3 feet ditches inches
French Drain Required: a t
Authorized State Agent Date 5 ~0 10
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