OPHTE# "~.el Harnett County Department of Public Health
PERMIT # `~-~033 Operation Permit 21 7 7 7
New Installation ~K Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S~ lei,%" 'CCp (G2-,,F7-NN V-1
Name: (owner) ~c,~aa~~t c•,~ ~ac,cy SUBDIVISION 5 oEy LOT #
System Installer: ~st,V-- 7 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 5
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well MC) 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
Q- uc \
~c \ EP~k2 t U _ \
EE 1
~`Ysg
PERMIT CONDITIONS:
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 cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E-2--'V1-cjw Septic Tank: 1500 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a each ditch a~0 feet ditches 3 feet ditches 0? inches
French Drain Required: fee
Authorized State Agent _N F-C-10 Date -0 b
A
S~
'!yam
, iL`• ~
~
~
a~
"
aF
5
x
r
~a a
F
G t
r
Q
M1
~N gt`
yw a'
# Y
n;
i
y N
b
O
a
k
4 ~ 9~`
A!
t 3 SF
t s r
S° ~ `'~,M
~ r