OPHTE# ) I -5- y&,�a Harnett County Department of Public Health 24661
PERMIT # 'I -3a I Operation Permit.,.
mew Installation optic Tank 9-1trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_4/O Ccclsa /- ;;K tJr.Lti/ te�4-qb � i�f/
Name: (owner) C-0140(* 110MK� 1nG SUBDIVISION Gcr)55 L+nom �lac� LOT # 9
System Installer: QOaA-t l' s -Registration #
Basement with plumbing: ElGarage EO urssber of Bedrooms -3
Type of Water Supply: ❑ Community ER' �Public ❑ Well Distance from well 4�c feet
System Type: Z.5iv'-72� Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This intim h. hem invalbd in rmmnli.,p dlh mnnlinhl. Nnnh r ... hm r......1 <nnu., R.a.. — C...... T...,....., ..A nl..... I ._I .n _, n_
rcnnn wnuulvna:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
Iql Z$i� rLP9JLt iU 1J
Alarm ❑
2EPar2
Following are the
specifications for
the sewwagef tsposal system on the above captioned property.
?9T
.au
9 a?
i
❑ Conventional
C
Septic Tank
1000 gallons Pump Tank gallons
Subsurface
No. of
exact length
':
n Z°
depth of
o ; ;=I
ditches
33rc
ditches
3 feet ditches /i3 _ inches
�
ca�ss c-r,..sr hns�s�
rcnnn wnuulvna:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sewwagef tsposal system on the above captioned property.
Type of system:
❑ Conventional
[d' Other Chc,sIc
Septic Tank
1000 gallons Pump Tank gallons
Subsurface
No. of
exact length
':
width of
depth of
Drainage Field
ditches
of each ditch 0 feet
ditches
3 feet ditches /i3 _ inches
trench Brain Required: Linear feet
Authorized State Agent G - -lam Date o �3zZd/wt
V)
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