OPHTE# 15-5'6704 Harnett County Department of Public Health
24081
PERMIT # 2%S3H Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: LN
Name: (owner) Je`r"�'S Pa.t_ Gygo—\ d SUBDIVISION LO'
System Installer. C-vctdf.—Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type:— V a�n. Types V and VI Systems expire in S years.
(In accordance with Table) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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This system has been installed in compliance with appliable North Carolina General Statutes. Rules for Sewage Treatment and Disposal. and all conditions of the Improvement Permit and Constmaian Authonation.
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rcnnit sununlum:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal, _system on the above captioned property.
Type of system: El Conventional 12%Other G. Z -'Fa -OW Septic Tank: VCP 00 gallons Pump Tank: gallons
Subsurface --Ne a exact length width of depth of
Drainage Field ditches of each ditch C feet ditches .3 feet ditches inches
French Drain Required: feet
Authorized State Agent 3" �hy Date