OPHTE# t q"ZOZ Harnett County Department of Public Health
24390
PERMIT # zR zs z Operation Permit
"w Installation D7Septic Tank (cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Y'53 ✓ao� 20 d �� lsa)
Name: (owner) ►Jo��.S Y�uAs o� S� SUBDIVISION LOT #
System Installer: Co -y G %2Scr{ Registration #
Basement with plumbing: ❑ Garage C amber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public 9-lefl Distance from well "'00 4 feet
System Type: �LS 5o Itt A4a x: o ATypes V and VI Systems expire in S 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conswaion Authorization.
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I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
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 8'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sewage dis sal system on the above captioned property.
Type of system:
EI Conventional
Cher 25 is ✓✓✓� - ,ro e-tv- 3
Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
T of each ditch go feet
ditches 3
feet ditches 09_2 inches
French Drain Required: Linear feet
Authorized State Agent Dateo/�—