OPHTE# -5'LCA3) Harnett County Department of Public Health
PERMIT #-503-t Operation Permit 21 7 8 2
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -F.GG~s~tt_t C,~~vn cai f4D
a LOT #
Name: (owner) --SS RpsT-c DES SUBDIVISION 7Py Q)
System Installer: c~~ , C>> cK~-~c~~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1~® feet
System Type: 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 Ntatutes, Nules tar )ewage Ireatment ana
ana an conamons of me improvement rermr anu lonsrruawn eumunLa W11.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other C::::2- ~-i. ",t l
Subsurface N of exact length
Drainage Field ditches' of each ditch `10d feet
French Drain Required: e~
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: ~ <7~0 1 gallons Pump Tank: gallons
width of depth of
ditches 21 feet ditches )i inches
Authorized State Agent_~a O5 Date
-a ,
f;
f
` mac ~e
t {
;
~
a:
'
•
•
7
e. ^F
,x"",xyM..tr
Y
g»~aa.,. j
~r
i rid
x
'
y c
- '~y,~,~~
'
,
.v
x"
r
i
z •
w
x
j
.
a
~
tt ~ ~ q
.
r
!
.
; -
i
Hat a ~ R
o$ -s -ao53 1
c