OP RHTE# 1 '5 -41y 53Z Harnett County Department of Public Health 24141
PERMIT# °77 S5 Orteration Permit,0"
New Installation Septic Tank 0f Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ :;155
Name: (owner) og \� r �� SUBDIVISION LOT #
System Installer: 64<,ncA (its 5 Registration #
Basement with plumbing: ❑ Garage uBedrooms 3
Type of Water Supply: ❑ Community C3 ublic ❑ Well Distan a from well '--a i4 feet
System Type: d Si- ti" % .t Lrr, 414 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.
nas peen mstanea in comphance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal. and all
of the Improvement Permit and
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 ❑ No Q�—
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Box ❑ Pump ❑
0
N MtL rd,, srD
H201-ine ❑
following are the
specifications for the
sewage di al system on the above captioned ro erty.
Type of system:
❑ Conventional
Cher G� r=l0. t� Septic Tank: rOOG
gallons Pump Tank:
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 3
of each ditch SU feet ditches 3
feet ditches aG
trench Drain Required: Linear feet
Authorized State Agent Date Ul I a z/I ac)l%
PWR Line
gallons
inches
tf t
J"
JAY