OP RHTE# 1 0 --5 -ai-1 G9 39- Harnett County Department of Public Health
PERMIT # ~baQ2 Operation Permit 21 5 7 4
New Installation Ts~, Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L-oyC Cr c C4Ny r a gL
Name: (owner) C 4 p, ON SUBDIVISION LOT #
System Installer: C-~AnNs tANLwo Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms_
Type of Water Supply: ❑ Community V, Public ❑ Well Distance from well S C O feet
System Type: r .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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules [or Sewage Treatment and Disposal, and all conditions of the
-J--1o'
No Hopi rs
t aS le w+-•. I
o•+
t REP~IC>_ I
Q
~osY
¢eb ~
L-01E GQovE C-Hung-A e-S~l c".•
PERMIT CONDITIONS:
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 ❑ Na><
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Permit and Construction Authorization.
❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other -~t-0 V,/ Septic Tank: 1000
Subsurface No. of gallons Pump Tank: gallons
exact length width of depth of
Drainage field ditches 3 of each ditch
feet ditches 3 feet ditches ~ a inches
french Drain Required: ~`liee2r feet
Authorized State Agent N~ zt~'~~~~ Q-e~5 Date ~ 1.3110