OPHTE# 1--5-t-/0g61 Harnett County Department of Public Health 24416
PERMIT # Z $3T4 Operation Permit .
LR- New Installation eptic Tank 2Y1trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: A.tr� o �r _\�� s� n b.
Name: (owner) W-tt)c. Cnrsttur -loan ,Tyr_ SUBDIVISION A LO
System Installer: T rn Registration #
Basement with plumbing: ❑ Garage� �um er of Bedrooms
Type of Water Supply: El Community [+-Public ❑ Well Distance from well feet
System Type: 2$ `o a , Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mu 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 Construction Authorization
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PH1111 LUNDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
D■n
H2OLine ❑
PWR Line
Following are the specifications for the s1wwage osal system on the above aptio erty.
Type of system: El (on L'Y Other r%2 r10 "S �I— Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch /0 feet ditches feet ditches 'Z N inches
French Drain Required: linear (e
Authorized State Agent Date 0 0S' % Z01 -q
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