OPHTE# '(I -�5 --qoqTS Harnett County Department of Public Health
24410
PERMIT # 2-130r- Operation Permit
"ew Installation P-1eptic Tank �rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: lAs 4Ol
Name: (owner) 7a ( SUBDIVISION LOT #
System Installer: T- t1 6ad6v,\0 _ 5,cai,c a Registration #
Basement with plumbing: ❑ Garage of Bedrooms
Type of Water Supply: ❑ Community ❑ Well Distance from well feet
System Type: 7--5,% (1L3 ac 2c S mss _ Types 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 lar Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Contraction Authorization
rcnmu WRUIIIURY
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No EV
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage posal system on the above captioned property.
Type of system: El Conventional Other 2-sio 2�%awkton Ez ;5k. -z Septic Tank: IC%
G
Subsurface
to l�
exact length
4'
so
T
depth o
�'Z
r '
ditches
c Ft
feet ditches
�=uC,ME r� G
3S,
G
L
c�
J t t
t l
c �
tl t 6qt
sit
1
t m
vs'z3t' �j
rcnmu WRUIIIURY
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No EV
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage posal system on the above captioned property.
Type of system: El Conventional Other 2-sio 2�%awkton Ez ;5k. -z Septic Tank: IC%
French Drain Required: Linear feet
Authorized State Agent / Date d(, CO) Z / -LO IL
GY3 gallons Pump Tank: gallons
Subsurface
No. of
exact length
4'
width of
depth o
�'Z
Drainage Field
ditches
of each ditch5
feet ditches
feet ditches -' Zy inches
French Drain Required: Linear feet
Authorized State Agent / Date d(, CO) Z / -LO IL
L4