OPHTE# 16 -5--`'%'1'0 Harnett County Department of Public Health 24424
PERMIT# a`nOperation Permit
New Installation V Septic Tank � Nitrification Line ❑ Repair ❑ Expansion
n PROPERTY LOCATION: Bs_vE G-, P G
Name: (owner) n�� Pl�f- OCV)L0U)5 SUBDIVISION ti)P,o-4ac Da-Pce LOT # 10 1
System Installer. Eflmc Gwn,> Cg_ Registration #
Basement with plumbing: ❑ Garage R Number of Bedrooms 1
Type of Water Supply: ❑ Community ")i� Public ❑ Well Distance from well so0 feet
System Type: �T.. 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.
Ims system an teen installed in comphana with applicable North Carolina General Statutex Rules for Sewage Tratmem and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the abraptioned property.
Type of system:
❑ Conventional
Other G,- �e, Love CQ�'J Septic Tank
gallons Pump Tank: gallons
Subsurface
o. of
exact length width of
depth of
Drainage Field
ditches
S of each ditch ISa feet ditches 3
feet ditches c)o - inches
French Drain Required:
Linear feet
Authorized State Agent 7§�� r— sy �5 Date