OPHTE# /If -s P 37-3 55' Harnett County Department of Public Health 23220
PERMIT # 2"i'� Z-? Operation Permit
�ew Installation Septic Tank Dl ttrrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: T6�e1ri a�
Name: (owner) VeAi o SUBDIVISION LOT # i3 i
System Installer: K Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -3
Type of Water Supply: ❑ Community C"Public ❑ Well Distance from well feet
System Type: Z�'°.la 5 ,, d,F r-- ,1;,yt 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.
a
This system has been installed in compliance with applicable North Carolina
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
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:
of the Improvement Permit and Construction Authorization.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications
for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other Z5010 t i A—, Lw --
Septic Tank: il, tr � gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch �� feet
ditches feet ditches 26 - Zo —) 19 inches
French Drain Required:
Linear feet
Authorized State Awlf[",�__ ,a,,t�-� '�- '2 Date ?— ° —