OP RHTE# (~$-,Sots- a t 35I
,R Harnett County Department of Public Health 2 0 9 8 7
PERMIT # Operation Permit
(K New Installation & Septic Tank ❑ Repair 4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: t 6s
Name: (owner) C1-1 _ SUBDIVISION oRcSr 0A1'r'5 LOT #
System Installer: • 5 Z2, L Registration #
Basement with plumbing: ❑ Garage ' d Number of Bedrooms 3
Type of Water Supply: ❑ Community iZ Public ❑ Well Distance from well j~ feet
System Type: P-- Z FSow dd~ 1,17- / 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.
um srxem nas ueen mstaueo in compuance with applicable North tarolma General Statutes, Rules for
?e7
J' 7
~r
,ten ~
" 5 i J9
and Disposal, and ail conditions of the Improvement Permit and Construction Author6tion.
croMlT rAkInlTlnuc.
NO STORM cl -
I. Performance: System shall perform in accordance with Rule .1961. ppn
II. 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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional "Other 2 Flow Septic Tank: 1 Oc3D gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch I t-) 3_ feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent V W Date 01-
f, r
J
. .~Y J1
Y-~r•
~i
f .v
5 Y
P y~
Y
Y
i
A
7
t `
v~-
L i
"3=%r
3
dx-i-
a