OPHTE# -a Harnett County Department of Public Health
PERMIT Operation Permit 21 9 5 4
14 New Installation 'K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M»2X5
Name: (owner) GV~,aFru.P,N~ 1~os SUBDIVISION SS~F~oczr~ LOT # 3Q
System Installer: V -E.Q w r,,\ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Ll
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 4 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
r
F,x,v 1 r
a~ ~3 usL
9
v~
Lo cu:-_Jnan Vet
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. 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 ❑
If yes, see attached sheet for additional operation cc
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above caps~~' nned property.
Type of system: ❑ Conventional Other ~~~f~tC2 ~Q l Septic Tank: ►OdG gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch IV) feet ditches feet ditches JA4 inches
French Drain Required: era t~fw
Authorized State Agent Date
s.
=7a
L -
P