OP RRRRHTE# Q I - =17 tir,~,,e Harnett County Department of Public Health 21 16 0
PERMIT # -2-S- 77 2~ Operation Permit
P'~New Installation Septic Tank ❑ Repair @'Nitrification line ❑ Expansion
PROPERTY LOCATION: rte ; J-Cti-6 Xd
Name: (owner) GreaS~ S'Ic. SUBDIVISION "ems}',, LOT # ~
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms 3
Type of Water Supply: ❑ Community Q Public ❑ Well Distance from well 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.
L'X t l
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment d Disposal, and all conditions of the Improvement Permit and Construction Authorization.
q~
t
Q
1C
--rw1
I LY C ~ r
~ f
MMIT rnitnlTlnllf.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Following are the specifications for the sewn disposal system on the above captioned property.
Type of system: ❑ Conventional 19 Other FZ- f~u Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ` of each ditch d feet ditches feet ditches i6 inches
french Drain Required: Linear feet
Authorized State Agent 14- 1~-f Date
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.
a.
O
7,
d 1
~
F` 7c'
y
_A
y
~
N
JOW
~7q
y
r~
"fit-' S ~t
nal
r
t
z
P
o
il,
l'y
f
x
~ ~
~Y l
~
s
rF ,r
•
Syr IF" ~
p
~
~
j