OPHTE0 1 -1; LCLta Harnett County Department of Public Health
PERMIT # 2~sT-6 Operation Permit 2 2 7 0 2
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G si,Q,lls~et\ h
Name: (owner) t.p.~,4 C mGcz ,c•,p SUBDIVISION ~A2S c_v NSH~P LOT #
System Installer: Gc g-m) Qa -x Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -14
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 00 feet
System Type: C,-) s-A-4 sz Cl s'a -Z~ 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 1000 feet
French Drain Reauired: '°~~LiaeaTt
Alarm ❑ H201-ine ❑ PWR Line
Septic Tank: \ 00 0 gallons Pump Tank: gallons
width of depth of
ditches '3 feet ditches inches
Authorized State Agent yes ~~~J\v-'\\ ks~~A6 Date 16
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