OP RHTE# 10-5--3EI'5O'CL Harnett County Department of Public Health
PERMIT # ~A Operation Permit 21 8 8 7
l New Installation "'R Septic Tank )X Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) Gs>,sL~-f 9-4~ (6~N sa
System Installer: 0-r~s ca•c.~~
Basement with plumbing: ❑ Garage Number of Be
Type of Water Supply: ❑ Community Public ❑
System Type:1
(In accordance with Table V a)
PROPERTY LOCATION: Hw~l `aid
n m Sr5 SUBDIVISION C;\,a E.s, 0 R' . LOT # 1y
Registration #
Brooms 3
Well Distance from well t b O feet
Types V and VI Systems expire in 5 years.
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 Construction Authorization
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PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ - Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z 5 LO %J
Subsurface No. of exact length
Drainage Field ditches t \ of each ditch a s feet
French Drain Required
Alarm ❑ 1120Line ❑ PWR Line
Septic Tank: t O o G gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches a"k "3 d inches
Authorized State Atrent QCZ-Y§~' Date `1 ~3 I1
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