OP- ENVH can not sign off in HTE - per D Johnson permits not yet purchased.HTE# `'6— 5- 31 ®-..t Harnett County Department of Public Health
PERMIT # ai'�33 Operation Permit 22544
❑ New Installation ❑ Septic Tank X Nitrification Line ❑ Repair AExpansion
PROPERTY LOCATION: r �D
J
Name: (owner) iAN s SUBDIVISION LOT # a
System Installer: G£cLp,to��£or.9 T- Registration #
Basement with plumbing: ❑ Garage IK Number of Bedrooms '+
Type of Water Supply: ❑ Community Public ❑ Well Distance from well LOO feet
System Type: c,, 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
�A� t
t � �
f +yQ
1
t
1
0
ti
Q t
t
�tPE
PLKMII CUNUIIIUNS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
-Nis PC><+.a..;
'V5 Rig— i>>L j 0 —1"%A I—
1�4 C
eriSSEK,. S£E Nq)T4NL. PECITKR
r—v¢. '5Qec'N= GKS ' caw
❑
D -Box ❑
Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional ❑
Other F--Z- t-oy
Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
di cchesf
of each ditch r S feet
ditches
feet ditches _ inches
French Drain Reauired:A
Authorized State Agent__\\ v \ \- Date 5
� —���31 �2,�
„us� ,
,: ,, c, .,