OPHTE# 1 - 5 q13&Harnett County Department of Public Health 24682
PERMIT # ZCYB'4 Operation Permit -
ew Installation Id�eptic lank tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3c,s.v,',ar_ szl <a;w- Scr- s`!/( )
Name: (owner) Y11r r tC - Ga zine. SUBDIVISION c- -t,, &,s LOT #
System Installer. Registration # tzZP�
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms `f
Type of Water Supply: ❑ Community &-Vub�fic ❑ Well Distance from well �� feet
System Type: ZSi 4 ro Tso Types V and A Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable North Carolina General Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construttion Authorization
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rtRNII CUNunIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ Alarm ❑
H2O1.ine ❑
Following are the specifications for the sewage di�sal system on the above captioned property.
Type of system: ❑ Conventional 12--ther 6� %%v w Septic Tank: 1000 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches T of each ditch 00 feet ditches — 3 feet ditches 45
French Drain Required: linear feet
Authorized State Agent %� ���• ����r�. moi' 5 Date 0 g/Z 0/ z0 i ;?
PWR Line
gallons
inches
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