OPHTE# 'LA- s -3 ; Harnett County Department of Public Health 24408
PERMIT # Operation Permit
ew Installationeptic Tankltrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 6 g Lj 'moo C I / fad . -m N/$9
Name: (owner) WAtq ConsLr%Y-4%d r` SUBDIVISION AA, 19.,nd• LOT # --Zi
System Installer: c4nn; MVnbs;,s] Registration #
Basement with plumbing: ❑ Garageber of Bedrooms �
I
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well feet
System Type: z 5 pv 2ed� 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 Whom, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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.
❑
25-6 T
ZJ/' /L e£OULTIUN
H2OLine ❑ PWR Line
Following are the
specifications for the sewage osal system on the above captioned $roperty.
k0( v
❑ Conventional
ZSiv ii6aFs;l�ica�t f'?J Septic Tank:
S
Subsurface
No. of
w1 W
depth of
Drainage Field
f�
of each ditch 60 feet ditches
:3 feet ditches 'Lft •��Cinches
Igr
n t
GP
4ti2
Sa=o
f'c2cN
5d
U trt.f= S7 rze—T�./'
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage osal system on the above captioned $roperty.
Type of rystem:
❑ Conventional
ZSiv ii6aFs;l�ica�t f'?J Septic Tank:
l7i Sc-% gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches J�
of each ditch 60 feet ditches
:3 feet ditches 'Lft •��Cinches
French Drain Required: linear feet
Authorized State Agent �� Date