OP RRRHTE#O°1 'S'a''r1~La~L Harnett County Department of Public Health 21 3 5 9
PERMIT # ~l Operation Permit
New Installation Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion
PROPERTY LOCATION: Ruf--F N N Rs~
Name: (owner) 'Op v ~ o ti CtN:-y So w G~ SUBDIVISION LOT # I
System Installer: 8It„o~.L Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms __Lj
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well 100 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.
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. J-)M RNs= NEL-b Cov F-0- ► O' 9" ~ WWEa L" ivE S u `r. 8 E GwEGicLf~ • 4' ~ ~ 16. IC,
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: `X Conventional ❑ Other
Subsurface No. of exact length
Drainage Field _-~jtches C, of each ditch
feet
French Drain Required: feet
Septic Tank: I OC) a gallons Pump Tank: _
width of depth of
ditches 3 feet ditches ~b
Authorized State Agent
Date 4
gallons
inches
W-7m -2
i s
L
) ~ t
t~F a .
~h u _ 'fir ~x
s +
71
r ~
c
E
y G
2 ~F t~
4 R y
1
f k> h i~d~
i
i k
25 i'.r Y~7