OPHTE# "MO Harnett County Department of Public Health
PERMIT # Operation Permit 22147
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) Ga E6 4 s0 t.j
System Installer: Qrn s 'c--` °M)4::*,
Basement with plumbing: ❑ Garage "S< Number
Type of Water Supply: ❑ Community `K Public
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: t4G:;0Q
~BM~s SUBDIVISION G ws,-~3 Oov-s LOT # 14
O Registration #
of Bedrooms 3
❑ Well Distance from well tbC-*) feet
Types V and VI Systems expire in 5 years.
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
PERMIT CONDITIONS:
1. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposa system on to above captioned property.
Type of system: ❑ Conve i I Other y rn4 l o a-2, aw Septic Tank: 403030 gallons Pump Tank: 10003 gallons
Subsurface No. of exact length width of depth of
Drainage Field dit es t of each ditch feet ditches feet ditches inches
French Drain Required: et
Authorized State Agent \\A\' ~ \W\ Date _ ) 61
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