OPHTE# M-s-a~5 } Harnett County Department of Public Health
21519
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~~v,t.~£.
Name: (owner) SS 4cop~c~ SUBDIVISION LOT #
System Installer. ZSo'-",~ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well 1Oa feet
System Type: 1> 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 s
F ystem nas oeen 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.
b L- PQ
A2F,~
C ~ - - _1r
3 6 6Z
9-
• , 14
Q-00
F611 D
P q,
1OLD
13 5 cAs~.EN~
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation co
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property,
Type of system: ❑ Conventional Other C2 qi-oy„/ O
Septic Tank: s80 gallons Pump lank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch a, of each ditch 4 feet ditches 3 feet ditches A Inches
French Drain Reauiretlr.
Authorized State Agent Date I I, id)6
AWAW
~C
l
z'
t
~
C
S
w f ,
c
h,
E
e
r ~t
Al~
A 4 r
w
Olt,
-~It
J ti4