OPHTE# 1 -1 - 5-"t tb`1� Harnett County Department of Public Health 25038
PERMIT # a��CO Operation Permit
( New Installation NIX Septic Tank �K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 68 Ppgci-,E ►oA.ea
Name: (owner) _ Qa EC,,5 -, a ar. SUBDIVISION Sumgn'GLL.+N LOT # a
System Installer: Ggo• 6 GPS ,,Grz Registration #
Basement with plumbing: ❑ Garage 10- Number of Bedrooms t -d
Type of Water Supply: ❑ Community �R Public ❑ Well Distance from well feet
System Type: 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 nas been installed in compliance with applicable north Carolina General stances, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authoma on
�Rf�C1aG 2'K%a,
n
0.
`02.tiQs>sa 1
c
c t}nGA + HouSE
cos t
t
M+ �5 O r W 6- L Gy 'RSA
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above capaoneFI property.
Type of system:
El Conventional
X Other Pvta+P-Te 14.14)Septic Tank: 100
gallons Pump Tank 1 6 t 0 gallons
Subsurface
No. of
exact length width of
3
depth of
Drainage Field
ditches
l of each ditch ano feet ditches
feet ditches '�'�" inches
trench Drain Required: Linear feet
Authorized State Agent ���/ � Date Oaf (<2q ����