OP RRHTE# C,)C,-5 ---16H36P-Q- Harnett County Department of Public Health
PERMIT # ( Operation Permit 21 9 01
New Installation _K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
ckC~li I~ znVea+v-~1e/-S PROPERTY LOCATION: G a~svlLi C G~v~c~ q-9
Name: (owner) C,-Z~ ofl ^C SUBDIVISION OAS LOT # Q_
System Installer: J >c~t ~crl Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 5~ Public ❑ Well Distance from well 100 feet
System Type: 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.
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
< R
n
~5b
~ lam u sE
a ~
GL
r
c..
Z50 Llv 00L&VraZjD
PERMII CONDITIONS:
1. Performance:
II. Monitoring:
Ill. 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 ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional El Other P v mp 7 0 a Z ~S c11~ Septic Tank: gallons Pump Tank: \ MO gallons
Subsurface No. of exact length width of depth of
Drainage field ditches ti of each ditch S Q feet ditches feet ditches t ° - inches
french Drain Reauired: Li feet
Authorized State Agent ~\5 Date a-E 161 o