OPHTE# ';t, Harnett County Department of Public Health
PERMIT # z~05 Operation Per ' 21 7 3 0
New Installation Septic Tank Z Nitrification Line ❑ Repair ❑ Exnansion
PROPERTY LOCATION: -jtZ i9jZ r~
Name: (owner) SUBDIVISION Rbtg.~- p LOT # j -7
System Installer: old Registration #
Basement with plumbing20mmunity Garage umber of Bedr ms ..3
Type of Water Supply: ~/IPAHC ❑ Well Distance fro well feet
System Type: 21 i& a, 1;e, {a fv 1~ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner must conta 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
YtKMII LUNUIIIUM:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal sfstem on the above captioned property.
Type of system: ❑ Conventional Other Z S% 2D U Septic Tank: I0 0 1-9 gallons Pump Tank: 10 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Ag t Date '
,
r ,
JIA
r + r
jj~
r y.
.
.G 9 ~ f
t. '
b
'oj
r7l
a 4N t
44
E~ yq.$5~} y~~. ~ y'hG tl ~ ' ~c1~
r y 2 f p 4
+4"
'Cir yi Mf y~{,CF`114 /ns
P*P
a
~r n Y
z
~
!v ~ - -
r~~ ~`3
'
_
a
~
` K
A
~
. 1
rJ fi ~
t~ ~ 4
'
:fit
,
-
- f 2
~ r
~
+0 4 "
T
~
~
Y
~ ~
f 3 ~ L
f y
5
*
~
i, ~ ~ ~
~ Y ~r ,f ~ ~ q~ ' *8 ~
~ u~
' ~
~
t e
.A
Y
~
~
G
r
~j to
~ '
,
8.
~ ~ t ~
:
~
~ .t
[
`
kh
dk.s .d. a. ~ ~ ~ ~
L ~eu~