OPHTE# f 0 Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 9 9
New Installation Septic Tank ~01itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: pa.~c.
Name: (owner) Howtaa-s9 v iL~Gas SUBDIVISION t ~~~otzP LOT # 83
System Installer: S so Vxao ,tr j Registration #
Basement with plumbing: ❑ Garage ~kNumber of Bedrooms T
Type of Water Supply: ❑ Community R Public ❑ Well Distance from well 1010 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.
This system has been installed in compliance with applicable North t.arohna beneral )tatutes, Rules for sewage treatment ana tnsposai, ana an conamons os the
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PERMIT CONDITIONS:
1. 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 ❑ I!OX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capti` property.
Type of system: El Conventional ther Q-tkm EA , 0L\ Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exa length width of depth of
Drainage Field ditches ac h aQ0 feet ditches 3 feet ditches - inches
French Drain Required: earl`
Authorized State Agent O \ r~ 111)~ 1-1 \ y__156 Date .t
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