OPHTE# o~_~3x I1 Harnett County Department of Public Health
PERMIT f Operation Permit 21 6 4 4
New Installation El" Septic Tank Rl' Nit 'fication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0 /d '3 C/-c- - k e4L
Name: (owner)s ✓ ~a~ a 4 SUBDIVISION LOT #
System Installer: z~ak ( ~t<. Registration #
Basement with plumbing: ❑ Garage &?'Number of Bedrooms 2
Type of Water Supply: ❑ Community ❑ Public d Well Distance from well feet
System Type: _ 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 farolina General Statutes, Rules for Sena Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
i
CxY~tl ~ I
c'
1 C
`s
o[ouir fAtin TIAUf.
~VV "VIIIV 11.
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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. ~f ✓ l lw✓l~r . l(er J'~;'~
❑ D-Box ❑ Pump ❑
Following are the s~pe' cations for the sewage disposal system on the above captioned property.
Type of system: L~ Conventional ❑ Other
Subsurface No. of exact length
Drainage field ditches 2- of each ditch / d o feet
-4,- 1-1201-ine W/
Septic Tank: i gallons Pump Tank: _
width of depth of
ditches 3 feet ditches 2 y
PWR Line
_ gallons
inches
French Drain Required: Linear feet
Authorized State Ag Date 9 -/D
Alarm M
n
N ~
s ~
L1
N
~ " ➢ art'
t
".gamdFe~,rM1' ~ .
i A
F~l'#
f
C
w! '
# t
fY1
' `~yFy
aR k•.^# ~K
i .
~Ho~y