OPHTE# 10 -s=` 7 Harnett County Department of Public Health
PERMIT Operation Permit 21 6 4 2
New Installation 'M Septic Tank )k Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C.Lvac.._ gD
Name: (owner) M N N t4 cT ~a+R.,'N~Z SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing ❑ Garage Number of Bedrooms 73
Type of Water Supply: ❑ Community )R Public ❑ Well Distance from well t 6O feet
System Type: X--N-v b 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 for
T
GLP~t>t
~O
Treatment and Disposal, and all conditions of the
Permit and construction Authorization.
56,
1
a i
~ f
~ ^t ~'Er`r'r 1t7NA(a
PqN 2, f^t
1
D cL\ .r
C5
xCO~
PERMIT CONDITIONS:
I. 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.
F2 me
LaQ cr S-r s , " a 9, L 6c,"40
❑
D-Box
❑ Pump ❑ Alarm ❑
H201-ine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captionad property.
Type of system: El
Conventional
Other E--'2-;E0--j Q v p Septic Tank: 16 oD
gallons Pump Tank: 100 d gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
French Drain Required:
ditches
of ea ditch 18 CPO feet ditches 3
A
feet ditches_ _ inches
Authorized State Agent Date C~ t~ 1
t
S"
~.1
~ v
f
E