OPHTE# `\-5~.)65b 6 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 2 4 9
New Installation ' X Septic Tank Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: Kooy~Z
Name: (owner) GE-\C2j V\Q M~-5\N c- SUBDIVISION LOT # 'a5
System Installer: 71R) SQC" r_:~ Registration #
Basement with plumbing: ❑ GarageX Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 5 0 O feet
System Type: `"`>1^s 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 LUNU1ITUNS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
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.
Other: ~v~zy l Q v~ \r~ae~vG, Gca~; G,r . 5cE S,Aot~a,5~o~ c`1P~ G on ~xar oC~at IAN
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the a~bboo^v~e~ captioned property.
Type of system: ❑ Conventional Other Yyny -S ° l..a-an``) Septic Tank: lOOO gallons Pump Tank: 1 b0 gallons
Subsurface No. of exact length width of depth of
Drainage field -ditcher- of each ditch feet ditches 3_ feet ditches inches
french Drain Required: _ ~t
Authorized State pent T__ ~`y-~-a-~; - \\uiv*5 Date
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