OP 3 pg document - with 1st pg of notesM-57, IS47"17
C / T
bt~ Cen-Ir0. I rn~:~ f,n~
Neck; z~, ~~07
pp~pyfm;-4 Oas
(vas °n h ~ d
nod
,~S34t e d
~ec~u se~
f ~S ilk- e d ~
E/~Qas
V/P
UW a S ~ Ca-~ c/
~errrcc~' ~n 3~grjD
A Tn~
HTE# 0 LO-- Harnett County Department of Public Health 19199
PERMIT # e2
~3
1 Operation Permit
New Installation ,Lj k tic Tank ❑ Repair U- Nitrification Line ❑ Expansion
PROPERTY LOCATION-
1~ LOT # Name: (owner) SUBDIVISION
System Installer: ( w Registration #
Basement with plumbing- ❑ Garage J~J Number of Bedrooms
Type of Water Supply. ❑ Communi 4,U Public ❑ Well Distance from well feet
System Type: A, • , I,, `A J='-, 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.
ims system nas peen mstimeo in
with appnc" north larolma beneral Statutes, Wks for Sewage Treatment and
and A conditions of the
dD k
ent Permit and construction Authorization.
G~
i Lnnn wnuntvna.
I. Performance: System shall perform in accordance with Rule .1961. S
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ 0-4
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: ❑ [onventional Y Other c )A y Size of tank: Septic Tank: gallons Pump Tank: J~ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: _ Linear feet
Authorized State Agent
Date V5
w"z
1'i,¢', , H k"
r`"A~/
1 _
r N~ ~
~
x
v~ a
i
w;
"`'C
,,,~,:r'
° 4
.
G~
Cl