OPHTE# I -; —.349% Harnett County Department of Public Health 23485
PERMIT # ZE3b(Q(O Operation Permit
L�J New Installation 2" Septic Tank Vitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:<Y /5'y 2 00 I�tzLES Cgegf 1� rZ6
Name: (owner) SUBDIVISION LOT # _7
System Installer: Registration #
Basement with plumbing: ❑ Garage 2)[Umber of Bedrooms
Type of Water Supply: ❑ Community I!1 Public ❑ Well Distance from well feet
System Type: _ 1 S% r71� cttAp--s Fes_ i pc- r 6 rbZpes V and VI Systems expire in 5 years.
I IL (In accordance with Table V a) Owner must contact alth 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
rtKPll l IUNDI l IUNN:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12OLine ❑ PWR Line
Following are the specifications for the s a disposal system on the above captioned property.
Type of system: El Conventional Conventional Other 2591b /ZG,W ;Fng 4,2 Septic Tank: / 06p gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z- of each ditch I ZD feet ditches 3 feet ditches 24 >) R inches
French Drain Required: Linear feet
Authorized State kenc�'-- <� /y ( Date 11-10—f
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