OPHIE #ISS -mus Harnett County Department of Public Health 24074
PERMIT #S Operation Permit
New Installation '�R Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Y.,,,N,> CQar---,e- R
Name: (owner) G ,BsoO 9�o,ac o 2 NAvyA SUBDIVISION k<-, N , S CZ�u LOT # 40
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System Installer: r�,� EvuWak� Registration #
Basement with plumbing: ❑ Garage 'K, Number of Bedroom
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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 seen installed in compliance with applicable North Carolina General statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comhuction Authorization
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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1
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
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If yes, see attached sheet for additional operation coillditions, maintenance and reporting.
❑ D -Box ❑
Following are the specifications for the sewage disposal
Type of system: ❑ Conventional Other
Subsurface No. of
Drainage Field dit
French Drain Required: to
—Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
!m on the above captioned property.
Z Fz.c vJ Septic Tank 16 O C gallons Pump Tank: gallons
exact length width of depth of
of each ditch 1-4-0 feet ditches feet ditches 1_�_ inches
Authorized State Aeent\\\\\�\ +�J= Date 5k� 11-c-
15- -,35 9i -i s-