OPHTE#_[~ -SO o- Dy g Harnett County Department of Public Health
PERMIT Operation Permit 21652
New InstallationpC _tic Tank Nitrification Line
CJ Repair ❑ Expansior
PROPERTY LOCATION:
Name: (owner) SUBDIVISION ca `
System Installer tt , ~r^k LOT #
Basement with plumbing 11 Garage i,-~Number of Bedrooms- Registration #
Type of Water Su ply: ❑ Community Public ❑ Well Distance from well
System Type: W (rfr Z` . 5'~ S 2 feet
(In accordance with Table if a) 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.
a
~7) 11,3,
PERMIT CONDITIONS:
I. Performance:
It. 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 `gL'-
If yes, see attached sheet for additional operation onditions, maintenance and reporting.
❑ D-Box ❑ Pump Alarm ❑ 1120Line ❑
Following are the specifications for the sewa a disposal s stem on the above captioned property. PWR Line
Type of system: ❑ Conventional Other `L- Cr \0
Subsurface No. of Septic Tank: gallons Pump Tank
exact length gallons
Drainage Field ditches width of ` of each ditch rJ~ depth of
French Drain Required: feet ditches- feet ditches
Linear feet- inches
Authorized State Agent
Date AD - 3 5 vu
II0 ~
l v
v )
F ry7;- ` d
r u 3s ^~4
1~ A
"No Y 14
t
7v I-M
t
T,, r r
47
's'r r
` - oc$4~r : ~ - Y Y y ye
S
f d~~ ~ r X2.
d.?RL' 46r ~ ,y {
T b ~L,
'
4
fiats
i fti~,F
r- a
17