OPHTE# i u��3Lr1�� > Harnett County Department of Public Health 24018
PERMIT #o_¢ Operation Permit
,X New Installation )K Se{p�tic Tank X Nitrification Line ❑ Repair ❑ Expansion
I PROPERTY LOCATION: f�6D1=0 w
Name: (owner) GPc:i c Q�Q;v" 4Et-Lls�s�5 SUBDIVISION GAa:1 L WtLL,a..s LOT #-7ir'ZL-
System Installer. ZPoa..t Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community NK Public ❑ Well Distance from well s00 feet
System Type: Types V and VI Systems expire in S 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 Consguaion Authonzaonn
W0000
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nq, e
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. ZW,%I0Q- 'I `Ss i—oCCX_fYD A1veaG fj n,&&L[V LANE k4Uiap__ \Fs,o wr ��a6/LS`o6
iov YRoPGet.: )
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E 2 Septic Tank: \ O C O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditrhes T of each ditch '24 0 feet ditches feet ditches A'.L— VW inches
French Drain Requ' In t
Authorized State Agent S Date