OP RHTE#O*-? -'--I7~o519. Harnett County Department of Public Health
PERMIT # 2 C~~`3 Operation Permit 2 1 7 8 6
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S-1 ggr_a
Name: (owner) 9,. Gsnc,j ~koM65 ~14 c- SUBDIVISION ~GCLSs~sY,o,,~ 1~~Lt_ LOT # 'i,3
System Installer: Te-o ~ruw ,..t Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1.00 feet
System Type: a 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.
inis sysrem nas peen inseauea in compoance wim appucaoe norm aroma aenerai mamies, naves ror sewage ireacmenr ana uisposai, ana an conomns of me improvement rerm¢ ana conscrucmn eumorizacmn.
65'` 5 ~~~'SSGc,Q1. ~UE,R
1-15 f
P
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned operty.
Septic Tank: 100 4 gallons Pump Tank: gallons
Type of system: El Conventional Other C'VNN 666 -LQv~ Cy-
Subsurface No. of exact length PD'-4 EL (q width of depth of
Drainage Field ditches of each ditch 6 feet ditches 3 feet ditches 2_ inches
French Drain Reauired:c-, near t
Authorized State Agent - ,~'w ~ 5,..,.. Date ~ f 1"1 C)
Al
-
-
^
~
V
r ,
e
r
u
^
c
.
r '
~
Ift,
R
nn 4
_
d
c
O~ - 5- ~`t1% 0 5~