OPHTE# II—S'Llt)"'S% Harnett County Department of Public Health 24875
PERMIT # Operation Permit
New Installation V Septic Tank Ja Nitrification Line ❑ Repair ❑ Expansion
(� PROPERTY LOCATION:
Name: (owner) gvtL�06aS SUBDIVISION 'MLOT #
System Installer: C;N — Q, SCrJ Ss G Registration #
Basement with plumbing: ❑ Garagek,' Number of Bedrooms
Type of Water Supply: ❑ Community s; Public ❑ Well Distance from well feet
System Type: =NP 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 matmled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and disposal, and all conditions of the Improvement Permit and construction Authorization
PtNMI I IUNUI I IONY
I. Performance:
II. Monitoring:
111. Maintenance:
IV, Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposal �YsYstem on the abo a captioned property.
CA2.r.`✓6
Type of system:
❑ Conventional
Other (��,ars@�CL }'.s J Septic Tank: 1000
gallons Pump Tank: 1000 gallons
Subsurface
No. of
exact length width of
depth of `>
Drainage Field
ditches
i of each ditch S $ feet ditches 3
feet ditches inches
French Drain Required- nl Linear feet
Authorized State Agent 4�5 Date 1 t' 1�
I-) 5--Li0057