OPHTE# 11--"1101 Harnett County Department of Public Health 24869
PERMIT # '2 9(100 Operation Permit�
ew Installation Septic Tank C -Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1389 UNc[ r't(h rz.a . G s a lyyl)
Name: (owner) ?v6�nv% i'vo ; SUBDIVISION LOT #�
System Installer: n— I ,e m.66 Registration #
Basement with plumbing: ❑ Garage Ea—Nrber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public 2—'Well Distance from well feet
System Type: '2 5 ° kg 4.1 , n S > 4 Types V and VI Systems expire in S years.
(In accordance with Table Y a) I Ow'ner must contact Health Department 6 months prior to expiration for permit renewal.
Thi, .v . ha hrrn ina.IbA In —.1i..... A —A-kI. u...h r,..r.. t.....i o..........._. 1. <_._ . - .. .
I. Performance:
II. Monitoring:
III. Maintenance:
IV, Operation:
V. Other.
System shall perform in accordance with Rule .1961.20.��
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 0-'
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
.. _._ .�._.. _.._ ..
2u PG�Lx'Y u ter;=
........... . r........ ........ .... w..,vv...vv .vmmu.nun.
Alorm ❑ H2OLine
I
l %I
l
Following are the
specifications for the sewagedioral
system on the above captioned ptyperty.
i� CB��Lfr �c¢s1
Type of system:
!{II
Uq CINCrn6er
Septic Tank: IOlaC' gallons
Pump Tank: gallons
Subsurface
%V/
i
width of
depth of
Drainage field
ditches
f
ditches 3 feet
ditches 90 inches
e
C
38ti s.�,
To
ft9 (52 17U1)
wIV V
I. Performance:
II. Monitoring:
III. Maintenance:
IV, Operation:
V. Other.
System shall perform in accordance with Rule .1961.20.��
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 0-'
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
D -Box ❑
Pump ❑
Alorm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the sewagedioral
system on the above captioned ptyperty.
Type of system:
El Conventional LY Other
Uq CINCrn6er
Septic Tank: IOlaC' gallons
Pump Tank: gallons
Subsurface
No. of
S
exact length
width of
depth of
Drainage field
ditches
of each ditch 100 feet
ditches 3 feet
ditches 90 inches
trench Uram Required: linear feet
i
Authorized State Agent 1 Date o 1 I 3 1
,v
i
:Y