OPHTE# 1-7—SS 41)S t-} Harnett County Department of Public Health 24607
PERMIT # a'tS0F Operation Permit
New Installation 'IR Septic Tank nNitrification Line El Repair ❑ Expansion
PROPERTY LOCATION: �ROssFA= T���Sa,tj R�
Name: (owner) _ W rrEAL H CsrGS,*s f: SUBDIVISION ? s �wel%N `-Sr ZlrN6 LOT # 8.6
System Installer: fir. S�ry,�tx, Registration #
Basement with plumbing: EIGarage 11!A Number of Bedrooms
Type of Water Supply: ❑ Community1 Public ❑ Well Distance from well feet
System Type:`1�, y Types V and VI Systems expire in S 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 Construttion Authorization.
s6o
sti Iso
to
a�6
VSE
I
Y
Ga�n�py OawG
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Max
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Fallowing are the specifications for the sewage disposal system on the above cag�pned property.
Type of system: 11Conventional Other �u+tio`�c Septic Tank t 00 0 gallons Pump Tank t 000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a of each ditch 10 0 feet ditches 3 feet ditches 34' sS inches
French Drain Realtaed�z-_ _ta nae We
Authorized State Agent -%c— � � M)%5 Date -7
I-)- 5- L1)69
n r.