OPHTE#) 6-5' 3%303 Harnett County Department of Public Health 24754
PERMIT # 2$7yus Operation Permit
New Installation Lam, Septic Tank � Nitrification Line ❑ Repair ❑ Expansion
{] PROPERTY LOCATION: Zy" v Da.�+f—
Name: (owner) GW,S&S `F>LILo t4 r. 1^s C. SUBDIVISION 16a.a LOT # I7S
System Installer: Gw4—,r4&2 Registration #
Basement with plumbing: ❑ Garage "&� Number of Bedrooms
Type of Water Supply: ❑ Community 'Dir Public ❑ Well Distance from well feet
System Type: TYa 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 hot been installed in compliance with applicable Rarth Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Fewer and Consuucnon Authanzabon
85 ,
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Bax
❑ Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captio9ed
property.
Type of system: ❑
Conventional
)< Other TOn�Q'Te (3A4,*8f4L1'A2[-3G
1a1°/ Septic Tank: IOOo'
gallons Pump Tank: 1000 gallons
Subsurface
No. of
exact length width of
3
depth of
Drainage Field
ditches
of each ditch a qS feet ditches
feet ditchesI 'w�e inches
French Drain Required:
Unhu feet
Authorized State A¢ent Q&hs5 Date
a
M14,
:rte.
r,
M14,