OPHTE# d`S-5 ~.StD Harnett County Department of Public Health 21110
PERMIT # ~5G~3 Operation Permit
New Installation X Septic Tank El Repair X Nitrification line Expansion
PROPERTY LOCATION:`~i~ R_o
Name: (owner) t5~t--L_ CL ~Mt s SUBDIVISION LOT #
System Installer: LARz~ S H AcZS~E Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well Vbd 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
1) LA
ok6
r
pQ L 1
A
fv ~ ( QUttiP iU f
A A 1 2+..+~/e I
C. 5 cze-o V Gr NO N
~ h i P~AlL AfZF14c _ ~o~O
N
T y
D
Q
3C'
V
C:
r ~nrnr wovnwna.
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No x
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other QythP 5 o EzF Septic Tank: 100 0 gallons Pump Tank: 100a gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch 370 feet ditches 3 feet ditches a-~ inches
French Drain Required: Linear feet
Authorized State Agent ~t5 Date ► 3~A' 0
f
r
to
0% rT
rs
~
c* H
~ n
I
n
l
t
Z "C IP
do
(D
o
r
o
m a
o
Ss
d
C7 7b
O. G
a
o
r a~
r
R
.01
man
p
3
H
t'
r
r
/
10 0
g~ •
O C 0
I'D
tl « o
p
oa
r rr
,p
N
j *C
pQ
Q~
O~
-
h
H
i G
r
(J~
ra
r, a
a
l- :
cr
cr
r
r
r
m
r
r it
a
a
i
co co h
o
R
`
t
m
h
o Q o
cL rr
a
j
3 x
r
t
N C Ct+
'
K
\
5~.
'
1Lw ~r Q~
S
rr'
f''
i ~
~ G
Q N
ro
A
r rt
c' rr
1
~