OPHTE# 17 —5" MI)q Harnett County Department of Public Health 24674
PERMIT # ZC/� Oaeration Permit, -
lbw Installation peptic Tank B—Citrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Oov-ebrook au,t ( ys do/ , -)
Name: (owner) Q,,La!tj. GrabEree oj&' inc SUBDIVISION Doranlcbrcxok Pi/v_.5 LOT # dX
System Installer: D> o is Med 1J o Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 4k-fublic ❑ Well Distance from well feet
System Type: 25` /Le.A, Pr 1 2— 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 Genenl Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS -
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tione roperty.
Type of system: ❑ Conventional Other i -F rlvo Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch IS feet ditches _ feet ditches--- inches
French Drain Required: Linear feet
Authorized State Agent Chi✓>�/� sa—: ,�<� Date
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