OPHTE#I66-1 Harnett County Department of Public Health
24288
PERMIT # Qx` A Operation Permit
New Installation R Septic Tank � Nitrification Line ❑ Repair ❑ Expansion
f� PROPERTY LOCATION: L-r--mJF-L— �LfiCY R�
Name: (owner) GA ,o )aSON \aOwnES SUBDIVISION C Pg— CES LOT # 44
System Installer. r -'PvNr- �t �f� Registration #
Basement with plumbing: ❑ Garage �* Number of Bedrooms Ll
Type of Water Supply: ❑ Community '�A Public ❑ Well Distance from well feet
System Type: *Aft -r-TT 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 Caroligpi General Statutes, Rules for Sewage Tream
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Q V ben DGL,
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.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
IV. Operation:
V. Other.
and all conditions of the Improvement Permit and Construction Authorization.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captio^� property.
Type of system: El Conventional X Other �.NstonSE� CQ� J Septic Tank Sd gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field c of each ditch '3, 00 feet ditches feet ditches Q'eZ inches
French Drain Required: _edr feet
Authorized State Agent "q5 Date 10