OPHTE# V,— 5- Harnett County Department of Public Health 24762
PERMIT # `�°1(d+-1 Operation Permit
New Inst;sUation X Setic Tank I Nitrification Line 11 Repair ❑ Expansion
p PROPERTY LOCATION: gTEw - Dosm 6
Name: (owner) SUBDIVISIONGgTGwe,Fl LOT #
System Installer: f -<L- SEA., . c,. Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: —I1 Types V and YI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
chis system has been insWled in compliance with appliable Ranh Carolina General Snare; Rules for Sewage Treatment and Disposal, and all mndifiom of the Improvement Permit and Construction Authoneaeon.
r'
r
Ren
AQE." r
t
33� �
HD V SE
R
C -
n. V (v a4
cz.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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:
Y. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispos3�system on the above captioned properT—
Type of system: ❑ Conventional I Other ((,- AI`%.,A6z--(.NQf G 1A10 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch 300 feet ditches 3 feet ditches inches
French Drain Re � Linear feet
MAuthorized State Agent Date I I
I
in
Fox
/\ \� \ » .
boa
n -s- q105,