OPHTE# n -5-�430C. Harnett County Department of Public Health 25082
PERMIT # Q N30 Operation Permit
X New Installation -'Nt Septic Tank )' Nitrification Line ❑ Pair El Expansion
Q PROPERTY LOCATION: �P2av6 N,La_ yuGCn jCJ
Name: (owner) �J�c�co UQX-- t" 1\ tCMG usLofns SUBDIVISION LOT # 2.
System Installer. GF_. r.5 S.P,x_cAaC. Registration #
Basement with plumbing: ❑ Garage*X Number of Bedrooms _
Type of Water Supply: ❑ Community 'X 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.
nils system has been Installed in compliance with applicoble North Carolina General Statutes Rules far Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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� 11111 ,.VI,YIIIVIN.
I. Performance:
H. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 ❑ H2OLimr
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
V Other Ez Fs -6w
Septic Tank too O gallons
Pump Tank gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field es
3 of each ditch I ON G feet
ditches feet
ditches I4 inches
French Drain Required:
Linear feet
Authorized State Agent \ k-1-0 Date
J� -'s - 1-) 3 0 ( &