OPHTE# Harnett County Department of Public Health 23966
PERMIT # 8 0 eration Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: TtPPG'SC V—D
Name: (owner) GgL-r c)C2- D --4 — ceF. — SUBDIVISION LOT #
System Installer: Sc.c,s., Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Es..ct.ovC-E�
Type of Water Supply: ❑ Community X, Public ❑ Well Distance from well 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.
I. renormaome: ]yAelll )IIAII permrlll 111 aQArUdIlu wit➢ num drvi.
11. Monitoring: As required by Rule .1961.
111. 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:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abovce �captioned property.
Type of system: ❑ Conventional 'A Other Q U+t1Q �c F�-FLOv Septic Tank: 1000 gallons Pump Tank: )000 gallons
Subsurface . of exact length width of depth of
Drainage Field ditches Z- of each ditch � feet ditches 3 feet ditches _�1L inches
French Drain Reauired:\ Linear feet
Authorized State Agent ® \\ �)AS Date
I c - 5-2`1�