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OPHTEHarnett County Department of Public Health 21 17 6 PERMIT # ~60 0 Operation Permit New Installation e Septic Tank ❑ Repair '6 Nitrification Line ❑ Expansion PROPERTY LOCATION: A' 9 Name: (owner) t~ ~1C n SUBDIVISION ~e.r1 2 0 ee LOT # f System Installer: ~A2/ar Registration # Basement with plumbing: ❑ Garage 5- Number of Bedrooms Type of Water Suppl: ❑ Community $Z Public Well Distance from well feet System Type: / j K t C ' a S ~ C, 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. S© L13, 4 ak,, ~ S ~ y j Fn 7L 4 C L 3 ~ L i MMIT rA11AITfALIC. 1. Performance: II. Monitoring: III. 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 itions, maintenance and reporting Following are the specifications for the sewage. disposal sy tt m on the above captioned property. Type of system: ❑ Conventional ther [4 t C'h B) Septic Tank: 1--53-0 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch feet ditches 3 feet ditches "Z~ inches French Drain Required: Linear feet - Authorized State Agent a7"~ Date lj Central C:trolina ttairdlnq, <J?i:' t. 3x]415992 616 Maxoy 't'own Rand I ~ :.2Ji41 d0U9 Cameron, tic ►82 26 1 11:11 02 - .1I°31;09 C1 Gcoaer . 0 L3 H out Hanu,al i& Truck: LARRY3HA.PP Tare. 00 LB H Hanual Wt C"5tower: 400038/1,ARRY 3EPI 60 1,13 Truck Type: Gump Truak :-rr: isles 3-. auantity Emit pa- Amount _ , . 1004k of M12T/2 r To 11, 3 Tana 2 l i249_a6 Or Ivor; ~ Deputy 46ighoeseitec: i, Elsa .i I ti n 4< nrit in d° tirs chips is from the Fuel Grade 'location ii n cord Moots 03R the Nlce chip ca o tia? "rat4vs'; .Stewatsr system app1' ation Fi Rock Aggroarato in Nltrilicalds. a ; ,t ;~;;a}~ ;ar t- s,