OP RHTE# iG-s-y�x�� Harnett County Department of Public Health 24660
PERMIT # 29Z66 Operation Permit
CI' New Installation R'Septic Tank P—INitnration Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:—)(,/ 6�'/ b m SM 1143 a l
Name: (owner) C-Cc�/10 ( motile, SUBDIVISION LOT #
System Installer. C 6 s VIC Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 2-fublic ❑ Well Distance from well feet vc:/abate c✓oy/�
System Type: 25 % - (2. -5 ;,sTt C 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 amoliana with aoolicable North Carolina General Stamm, Rules far {..w Tmarmnnr ..a m,.,,I ,.A,n r„.At; ...1 .w i.. .............. o.._:.... r --- ._._:__
rxmTn wnumvm:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 sewageAsposal system on the above captioned property.
Type of system: ❑ (anventional D;Other Septic Tank: f 00,f_� gallons Pump Tank: tCYC—> gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 25 feet ditches 3 feet ditches /Z inches
French Drain Required: Linear feet- Ir
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rxmTn wnumvm:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 sewageAsposal system on the above captioned property.
Type of system: ❑ (anventional D;Other Septic Tank: f 00,f_� gallons Pump Tank: tCYC—> gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 25 feet ditches 3 feet ditches /Z inches
French Drain Required: Linear feet- Ir
Authorized State Agent Date ow t 0 /Z,0 L`�
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