OP RHTE# I C-) --S-ati-~ LA30., Harnett County Department of Public Health
PERMIT # ta^C- t61 Operation Permit 21 6 3 6
\ New InstallationEk Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M A y.< V.p
Name: (owner) Coa 2vci~d N SUBDIVISION Cboer= > FPc.A,5 LOT # 'a
System Installer: H0 Q- rAs wr-~\ti(- Registration #
Basement with plumbing. ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community '~i,, Public ❑ Well Distance from well LOd feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
mu system nas ueen mstaneo in compliance wan applicable north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
'T A Lr,1
3~ z
t 9.5'°Yo e.6D i v
~ ~Ar1E.p~ y ~ 6
Z
J
7
O
6
1
r^ A2~~s 2D
nrnutr rnumm~
~nnn wnvnw .
1. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Ems- Sr"Low Septic Tank: tOo d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch ~ feet ditches 3 feet ditches r$-ati1 inches
French Drain Reouired;&- , ,~J_in~axfear
Authorized State Agent n~ \\~~~s Date ' fAa) ~ f Q