OPHTE # 11 --1-5 --5�'-6 Harnett County Department of Public Health 2355
PERMIT# ���- Operation Permit
New Installation 'K Septic Tank] Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Go�Gsgu2�
Name: (owner);,atitc_-Yr i ��� NG— s "4 SUBDIVISION LOT #
System Installer: )NQ- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms (S 5e8
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 Cb(D 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.
anis system nas peen instaueo in compliance wan applicable north Carolina beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
p �Ll- i1 -k S=G<-L11,P,s-10TJ CSN V1LC-rVN � "QA
rtKMII t.uNUIIIM:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other: na,,4 HcL C;a,.r;QL'C;' ZG®y )Q6b
Subsurface system operator required? Yes; No ❑
If yes, seettached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: 1i, 5 Cl n -s ; 15 c; �c.� `1�P.25 QZ4 Z11,���»G �Egi UIQLD
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field i of each ditch feet
French Drain Required \, Linear feet
Alarm ❑ 1-12O1-ine ❑ PWR Line
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent 7�� , � __ `rl5 Date 4aohS