OPH T E # ~ a - 5 at~ito Harnett County Department of Public Health
PERMIT # Operation Permit 21 6 2 9
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'a1W
Name: (owner) NN Co N-5"« -v GTE d N SUBDIVISION i i 6 E e.s Po E LOT #
System Installer. tb QN\F- s Registration #
Basement with plumbing ❑ Garage '*R Number of Bedrooms 3
Type of Water Supply: ❑ Community "R Public ❑ Well Distance from well t Q O feet
System Type: "12 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.
Ins system has been installed in compliance with aWicabfe North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
LibO
LI
GOL Q C
nrnwr rnunirin~~r
~ mini wnvn ivn~.
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
I 1-I- 'IV 11
❑ D-Box S) Pump ® Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Pu rhP ~n CkPr Septic Tank: 1 ocO gallons Pump Tank: I WO gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc e _ 1 _ of each ditch a, feet ditches feet ditches t ~ inches
French Drain Required: feet
Authorized State Agent Date
k
~r.
~ :y a
a _
PQ ' ~z~
•~j ii S i~
~.r
F
~Fq
mac,
a t
F T
y ~c
F
mss,
41
j
ism
xF
.y }
r
F
~
I
a~Y-°4sy ?~1
•
t
d
r 7-7
4 t
oil
.r
t
TWO
Alt:
Ivi
144 r
.
~;~"T*
.
e. ,
e }
r~
•
~ ~ .
'
~
a~ , ~ . '~1
~ C? ~.t.~re~-~