OP RHTE# O-)-5-1(~~3C,2
Harnett County Department of Public Health
PERMIT # a'1-_ Operation Permit
21 571
New Installation ❑ Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
v $L~,,~~
Name: (owner) EOw Ae.d PROPERTY LKATION:
SUBDIVISION G
System Installer. O 1 f,, i c-' LOT #
Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ti Q4
System Type: j~2 feet
Sy accordance with Table V a) Types V and VI Systems expire in 5 years.
(In 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.
IVQ
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑
Pump ❑
Alarm ❑
Following are the specifications for the
Type of system: ❑ Conventional
sewage disposals stem on the above captioned property.
V
--7
X O
H20Line ❑ PWR Line
Subsurface No. of
ther
v n, q
FZ„ i;j, ,
exact length
Septic Tank ~ o o o
gallons Pump Tank ~ o a d
p gallons
Drainage Field ditches `
F
of each ditch W d a feet
width of
di
depth of o<
rench Drain Required:
Un
e_t
tches 3 _
feet ditches 4 ~g inches
Authorized State Agent
0 C'1-1~ Date
T
;jP
400
WIN-
VT.
.'aJ.r F
00 S fir'
h
~p
a~
to -
.
}
s.
r
Y
Vol
c
rs.
ur
1 q
Atoll
may"' -~.1 a
~ A
5
J- .
t~
All
r
1
r
0-1-5-- 3(,,V-_
Y
.
WO
w57;
i
t
o ,
}
yk
h
Y .
~
'f
y
'
i