OP RHTE# 0-_1-5_ ) 251 "~Z Harnett County Department of Public Health
PERMIT # 'c4-(-,43:1 Operation Permit 21 7 9 8
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \Aoay6.2
Name: (owner) GN v~ ~o r, Es N G SUBDIVISION 1~ c as < N l~~ > LOT # 3'9
System Installer: ''moo R>GZ-ow N Registration #
Basement with plumbing: ❑ Garage );~r Number of Bedrooms 3
Type of Water Supply: ❑ Community --bk Public ❑ Well Distance from well 1®a feet
System Type: =12cz 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.
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 Construction Authorization
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Cr~~ n Q y ck QI~uS~ Septic Tank: 1 000 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditc es of each ditch S feet ditches feet ditches
French Drain Reouired:_~\ ~ ee
PWR Line
gallons
inches
Authorized State Agent \\~w C ~~+5 Date S q
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