OPHTE# 17 -5' 26194 Harnett County Department of Public Health
PERMIT # A Operation Permit 2 2 2 6 3
New Installation E3' Septic Tank F7 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION f5 ' i`
Name: (owner) f_-' G i-Jiss - , . SUBDIVISION LOT #
System Installer: Rvc:A44 1-14 11 a Registration #
Basement with plumbing: ❑ arage ❑ Number of Bedrooms .:3
Type of Water Supply: ❑ Community 2T Public ❑ Well istance from well /eet
System Type: i 17T Types V and ems expire in 5 years.
(In accordance with Table V a) Own r must contact Health Dep ment 6 months prior~d expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
Permit and
and all conditions
c
X563
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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the spe
cifications for the sews disposal system on the above captioned property.
end
4S0
f
Z006
Type of system: ❑
Conventional Other
_
Septic Tank:
gallons Pump Tank:
gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch 100 feet
ditches feet ditches Z `j inches
french Drain Required: Linear feet
Date
Authorized State gent -1 Z
_7 -.n -
r
12-5-28194 (1)
12-5-28194 (2)
12-5-28194 (3)
12-5-28194 (4)
12-5-28194 (5)
f
717
12-5-28194 (6)
12-5-28194 (7)
12-5-28194 (8)
12-5-28194 (9)
12-5-28194 (10)
t
12-5-28194 (11)