OP RHTE# OA-:- mac,, Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 4 3
New Installation ~n Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a-l VC-5--v
Name: (owner) NAJ G6 `;u c.;s e o SUBDIVISION "C; a G~ rt ~ati ~z LOT # 53
System Installer: ocn°a t- s QL-,) M51.", C. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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 seen mstaned in compliance wim appucaoie north carouna uenerai xatutes, tsmes tm
~e
treatment and utsposai, and an conditions of the improvement rermit and lonstruction Authorization.
PtKMII CUNDIHONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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:
Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ- ~-jz3w Septic Tank: \ OO 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch a6 feet ditches feet ditches 1ct inches
French Drain Reauired: rLine
Authorized State Agent V-"'t5 Date V-n1 s
Jvlitci 'CcL\VE