OPHTE# t0~5-~-3~~►~ Harnett County Department of Public Health 2 0 8 5 6
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1"lKg*-5'9
Name: (owner) tre.~~~ c, Lt V~o r-N E5 SUBDIVISION NSxEF 00-1> LOT # SO
System Installer. Qr .5 S-s sz~c, t ~,N~ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community "R Public ❑ Well Distance from well 160 feet
System Type: - ~ ~10 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.
❑m sprem nas ueen mstaueo in ccoom nnaance wim
1 rte/
norm larolma heneral Statutes, Rules for Sewage Treatment and
and all conditions of the Improve
`y0
S G- b/
MI
Permit and Construction Authorization.
_1 SG
I P UmP ( ~cl
tea,
71
:40, Sl)QPt_~ LsUC
5 v P?ly ~s"~~`
i
nrnwr rnun~r,nu1
4('-/
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.
Following are the specifications for the sewage disposal system on e abovta tloned_property.
Type of system: ❑ Conventional Other ^~p
~U b 1: `F toW Septic Tank: 1 b0 0 gallons Pump Tank 160 O gallons
Subsurface No. of exact length width of depth of
Drainage Field -`~ditegae 3 of each ditch 9 b feet ditches 3 feet ditches inches
French Drain Required: ine feet
Authorized State Agent ~~y~~\ ¢L S Date 41 \5
A x
~ c
- * 4,v
TLS ~Ilk
RT
F.
t yX
y
t
r
r
r ~r x x a
y ti, rr
r i % $
1~T~ f
lip
a~ eta ~ f~Jg
jj
a
n...
91
s°
a ~ N