OPHTE# a 7a! 6 Harnett County Department of Public Health 23934
PERMIT # ad deo I Operation Permit
L� New Installation ❑✓- Septic Tank C✓' Nitrification Line ❑ Repair ❑ Expansion
/, PROPERTY LOCATION: �i octf P4Name: (owner) M `Ker— f{c..cr SUBDIVISION GL k^on 4- LOT #1.3&
System Installer: G.e &ver .fr0!!�-: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _
Type of Water Supply: ❑ Community O'�Public ❑ Well Distance from well feet
System Type: trb 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 complianre with appliable Nonh Carolina General States, Rules to Sewage Trea ent and Disposal, an all conditions of the Improvement Permit and Construction Authorization.
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a
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
Other.
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.
❑
D -Box ❑ Pump ❑
Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa,�' disposa�ystem on the above ca tion roperty.
Type of system:
❑ Conventional 7 Other �'c.,.eya'�'o �.aiCK y��ar.bef'
Septic Tank: %GGt 0 gallons Pump Tank: �6� O gallons
Subsurface
No. of exact length
width of depth of
Drainage Field
- ditches of each ditch
feet
ditches, feet ditches inches
French Drain Required: _ Linear feet
Authorized State
Agent\' :H Date 3 ��
15-
j�-�3 7.Z