OPHTE# ( w - s - s'T II'f Harnett County Department of Public Health 24425
t b S 38 11`1
PERMIT Y Operation Permit �
9- New Installation ptic Tank CE N/itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 29 0
Name: (owner) ci e) C" fQ le-1yn SUBDIVISION t_ over LOT # 7
System Installer: L—c.tc y AVL000 Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms 3
Type of Water Supply: ❑ Community re Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a)j Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed In mmplia4e with apphcrable North Camlina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
11. 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 91
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: El Conventional 7Other /�2 C'hipy Septic Tank: 1 006 gallons Pump Tank: gallons
Subsurface No. of ` exact lelIgth width of depth of
Drainage Field ditches 3 of each ditch quo feet ditches feet ditches Zinches
French Drain Required-,—"\ Linear—ft
Authorized State
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PERMIT CONDITIONS
I. Performance:
11. 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 91
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: El Conventional 7Other /�2 C'hipy Septic Tank: 1 006 gallons Pump Tank: gallons
Subsurface No. of ` exact lelIgth width of depth of
Drainage Field ditches 3 of each ditch quo feet ditches feet ditches Zinches
French Drain Required-,—"\ Linear—ft
Authorized State
Date t