OP RFITE#_1_?-J--_3a ViErX Harnett County Department of Public Health 23115
PERMIT # a2-77a Operation Permit
New Installation LR' Septic Tank El" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /l/'c ado S
Name: (owner) Gooy A6 SUBDIVISION Cc-kr LOT # �
System Installer: GC- _rte .t& �IC Registration #
Basement with plumbing: El Garage ❑ Number of Bedrooms 41
Type of Water Supply: ❑ Community 2"-Public ❑ Well Distance from well feet
System Type: 12T b 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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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa dispo system on the above captione property.
Type of system: ❑ Conventional Other+ �,P '� Qu11 if . 4 e- Septic Tank: /� gallons Pump Tank: /00 t% gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches % of each ditch �7C20 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agen �,o —,,,
/`�'�/ Date G ////Z 0
1 52- L165-4