OP RRHTE# 10`5 aaC\gRC~. Harnett County Department of Public Health
PERMIT # asab~ Operation Permit 21 8 5 8
X New Installation J Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Nca.~i15
Name: (owner) Go,~t \N '~O N SUBDIVISION ~w c a O~~~s LOT # S4
System Installer: (Z -i » S-, ca.,-% c,~-t -,.tea Registration #
Basement with plumbing: ❑ Garage ;a Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well [Oa feet
System Type: G 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.
ims system nas peen instauea in compuance wan appucame Norm tarmma uenerai xatutes, rimes for sewage treatment and disposal, and au conditions of the
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Permit and lonstructton Authorization.
PLKMII CUNUIIIM:
1. 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 ❑ 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 'E-7- ~t ow Septic Tank: `Mu gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches t each ditch ~ feet ditches 3 feet ditches
French Drain Reauired\ ~
PWR Line
gallons
t 8 "gyp _ inches
Authorized State Agent i- \~`\~\\v\1\\QL-~S Date t '11 110