OPHTE# \ A-)577 Harnett County Department of Public Health
PERMIT # a C6_15 Operation Permit 2 2 2 4 6
)sk New Installation 15~ Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Uvc.P~-;
Name: (owner) "-L- Ci-Wt.L V omGs SUBDIVISION GAStoz~r>r~ C) LOT # Q-3
System Installer: 7SvraE5 Registration # T
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 (D 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.
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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rtKMII LUNUMUNS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. 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:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the abov~y caption roperty.
Type of system: ❑ Conventional Other C.~1w3E2 Septic Tank: 10c~®
Subsurface Jo. of exact length width of
Drainage Field ditches of each ditch feet ditches
French Drain Reauired: _ Linear feet
Authorized State Agent ~ Q~ 1~S Date
H20Line ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches Ai -3-3) inches
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