OPHTE# 10- 5---~Is3 Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 5 6
X New Installation 'K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C3l_~ ya}
Name: (owner) ~Sgm ~s SUBDIVISION Q o ss M~.C F stt LOT # 10
System Installer: M Registration #
Basement with plumbing: ❑ Garage '5( Number of Bedrooms S
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well )cc 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.
r
This system has been installed in compliance with applicablrforth Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
r4 P%L-
tvr \
Co ccv E~\ 0~`
a -
T
M Q so
C1 A5 3
V
G
rtKMIl LUNVIIIUM:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoIX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑
Pump ❑
Following are the specifications for the sewage disposal
system on the above captioned property.
Type of system: Conventional er
Subsurface No. of
exact length
Drainage Field ditches
c'
each ditch d feet
French Drain Required: Lt
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: 1 gallons Pump Tank: gallons
width of depth of
ditches feet ditches Ig at°i inches
Authorized State Arent 6'- lb Date 1
! O °-5 ;as3'~ 3
~
_
~
a
`
. ~m~t ~ k
d.,
i'
~ ,a
~
-
,n,..
y
.
_.a.
1
1
~
~
S
~.~~d_
~
a
~
f .xy',o-...
°
" ~
; f d~
,
7 ~ q,
r
_
r
~
r -
,
~ r.
,
~
a
z
~ 4.
o.
~
~
>m
r
, b,
v
~ ~
~
n ~ r
_
..,Uk
~
R 1
- r -
_
x
~ ~
~ ~ 1
~ ...x ~ '
a~
t
t
r
r
oaf
~
•
-
~
M. 3
,
~
~
~
A
k
~
~
2
;
P4~
~ $
~
M~
~
~
}
~
~~p ~
~
p x
-
'r
~
r ~
' .
f
_
L
_
r
-
i
-
~
a;
M
t ~ ~
-
.
-
~
~g n
~
~
'
r r
Y ~
"
`
x
1~
~
~
eny f~ `
3
it
~
.
n.
mN
'
~ - . , v^i -ham N- mt2»Z ~
~ , ...u~v... ± ~
~ ~
~ ..M A o
1 N
jA ''4u+G.2~ ~ Y"~,
. _
y -
ti
t
'al N