OPHTE# W? -,f-- ao19? Harnett County Department of PublK Health 21 1 2 3
PERMIT # -2 y s-73 ,Q eration Permit
New Installation Septic Tank ❑ Repair Vitrification Line ❑ Expansion
PROPERTY LOCATION: C.I~r'.~+ y r. L :cam Je4-
Name: (owner) cPti3'+r f ~o~e r =.u . SUBDIVISION Fco.^eyr4 7r,,, I v LOT # /1
System Installer: f~c~n~2 q Registration #
Basement with plumbing: ❑ Garage GNumber of Bedrooms
Type of Water Supply: ❑ Community C~Public ❑ Well Distance from well feet
System Type: G' 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.
Ihis 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
~j-Z
9 r r(/-C Cr
as
'rs it
a7~
3r 2
r it
, ~nru~ wnv,nvna.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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:
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: El Conventional l't Other _ C k Septic Tank: Wo gallons Pump Tank gallons
Subsurface No. of q exact length width of depth of
Drainage Field ditches l of each ditch feet ditches 3 feet ditches 18 inches
French Drain Required: Linear feet
c
Authorized State Age Date to/-~aea9
GIT- S=a 1~1 ~-47
p T11TIVI M
s F
All
All
ICA,
R' tf '~br 'lF 7Y
r ~
,r
l
k .
%r
it
a
ell*
t[,r ,t t a4v` +c ~
7
e
4
,R
t 44