OPHTE# 13— s-1►' 4-1 Harnett County Department of Public Health
23055
PERMIT # GS—%
Name: (owner) Pp o C;D t, a,s t2 w G.: o nt
System Installer: CrM-, S -Tcj-\
Basement with plumbing: ❑ Garage � Number of Bedrooms
Type of Water Supply: ❑ Community "K Public ❑ Well
System Type:
(In accordance with Table V a)
Operation Permit
New Installation Septic Tank � Nitrification Line El Repair El Expansion
PROPERTY LOCATION: C) r-0 V SLN4.�
SUBDIVISION 5��,�w,ry5 �`� ou LOT # 3
Registration #
Distance from well 193 Q feet
Types V and VI Systems expire in 5 years.
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
rimvi WN1111 RY
I. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 5- 2 Fi,a'w Septic Tank: 1 O b 0 gallons Pump Tank: gallons
Subsurface o. of exact length width of depth of
Drainage Field ditches of each ditch 5 feet ditches 3 feet ditches_ inches
French Drain Reouired: _ \
Authorized State Agent ng' 7! U Ns Date
AAA t
J
� I HOUSE
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W ►OGEo� Wf\y
rimvi WN1111 RY
I. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 5- 2 Fi,a'w Septic Tank: 1 O b 0 gallons Pump Tank: gallons
Subsurface o. of exact length width of depth of
Drainage Field ditches of each ditch 5 feet ditches 3 feet ditches_ inches
French Drain Reouired: _ \
Authorized State Agent ng' 7! U Ns Date
13.5° 31 `�A-)