OPHTE# 11;:~..S-~_~ Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 0 3
New Installation 'EVSeptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: CC-1(-X?, P- s G~~vcu~ey~
Name: (owner) \ ~cx~~~~~~NCr SUBDIVISION )P2 PU~,~~C LOT # ---,4
System Installer: Registration #
Basement with plumbing: ❑ Garage 'Ii?, Number of Bedrooms 3
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well 1 (!Dd 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.
finis system nas peen instmea in compoance wan appmatne none Laronna uenerai )tatutes, nines tar )ewage treatment ana ussposai, ana an commons of the improvement rerm¢ ana lonstrucnon nutnorization.
f R
T
I A
q
T
Q
~
T
E
f5 r~,v,
~A
T~
1
t
!
i
ME
D
H \ cmP....GG." to 11'~
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
❑
D-Box
❑ Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the specifications for
the sewage dispo I system on ,the above captioned property.
w
Type of system: El
Conventional
a 2. V--ow
X Other v ")sj
Septic Tank: _ gallons Pump Tank: 1600 gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch C7 feet
ditches feet ditches ~j~'a"-A inches
French Drain Reouired:
feet
Authorized State Agent A~~ '
-LA 5 Date ^1 ~t~
C
f
a ~
K~
~
qqqq
I
1 ~
~ r
s
S
/
b
fi ~
a~ a
r
.
3.
6Ao
y
`
~
f~
r
h ~
y
~
~
f✓
~
~
#
r
~
c
'
k
N~
L
J
U
. i
`
j
o
x
e
,
~a- 5-a`~n~3