OPHTE# 1 o-s-aWs9 Harnett County Department of Public Health
PERMIT # w Operation Permit 21 7 6 6
)KI New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~NgFrio58, 9
Name: (owner) Can. ,_P,.,~ ~r.,~} 1*•~ SUBDIVISION Co OL-1Ns,\ S~SoNS LOT # S_
System Installer. -J~-o ~czowt\t Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms _a
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~6 O feet
System Type: =1 D 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.
ims system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
►~p r
F
r
vuMe ~
, Ng6,m0 tV
\
QIcP1,,Q
Ar~.A
jO "6, , 1
Ala
SL'
X40
♦
f
.
om
~ ~ (
n
Q
}1 `
PFRMIT CUDITIAW-
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 ❑ N0A
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box
❑ Pump ❑ Alarm
❑ 1-1201-ine ❑ PWR Line
Following are the spec
ifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other GAo,Meciz- cc 1i
Septic Tank: 1000 gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch i'4.0 feet
ditches 3 feet ditches 36-1'v inches
French Drain Reouired
1&~t
Authorized State Agent 7 ~ ge s Date 1016