OPHTE# 0°1-s-D,-@A~ Harnett County Department of Public Health 2 0 8 0 7
PERMIT # a53'a'*6 Operation Permit
New Installation Septic Tank ❑ Repair Nitrification line El Expansion
PROPERTY LOCATION: QNy- ~--vcp,--, '9.o
Name: (owner) SUBDIVISION C.P~ot_Nrss~. C3.az5 LOT # 5~-
System Installer 3'o,4et, Swi,tr Registration #
Basement with plumbing: ❑ Garage '1!~L Number of Bedrooms 4
Type of Water Supply: ❑ Community -1 Public ❑ Well Distance from well s60 feet
System Type: _ =--Ir> 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 oeen mstauea in
with applicable north larohna beneral Statutes, Rules for Sewage Treatment and
~6CY
~d.3vepr'~0NK1- t
9- EPgSQ
W2,E , _ t
t
't
43 k6~4~
& 4
GAaoLIWA.0-w-5 C\Q.G1-C
r
40-
Permit and Construction Authorization.
rcnrui Lvnvinvn3.
1. Performance:
11. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. Powrac-- ~ Wb,, 6-1-
Following ID E ~+E
are the s ecifcations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other Septic Tank: IOCO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3~0 feet ditches. feet ditches inches
French Drain Required: tttnear
Authorized State Agent Date 51-56
and all conditions of the Impro
z~
a
~
"+S
a'
~
~
y
~t
}
,
s'.
_
.
g
g
i
_
~
i t
r ~
~
P,. ~
~
.
i
F