OPNTE# 11 s—`/C:k Harnett County Department of Public Health 24683
PERMIT # Z r t9 Operation Permit ���--
New Installation eptir Tank IXNiirifiwtion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ', ak 5 C syo
Name: (owner) (�Ii2nn bc�(t er- SUBDIVISION LOT #
System Installer: G1; rt(— ActmS Registration #
Basement with plumbing. ❑�arage umber of Bedrooms
Type of Water Supply: Gommunity ❑ Public ❑ Well Distance from well n/0 feet
System Type: ZS X. Rc,\.ti4;r 5 s r :; , 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 rompliann with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comnuaion Authorization
PERMIT CONDITIONS:
1. 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 sewage disposal system on the above wptipned property.
Type of system: ❑ Conventional EJ her C= Gl4, 'CS_C Septic Tank: t�y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch f UU feet ditches feet ditches a9 inches
French Drain Required: Linear feet
Authorized State Agent Date `7 f 0 S / �Ol —
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PERMIT CONDITIONS:
1. 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 sewage disposal system on the above wptipned property.
Type of system: ❑ Conventional EJ her C= Gl4, 'CS_C Septic Tank: t�y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch f UU feet ditches feet ditches a9 inches
French Drain Required: Linear feet
Authorized State Agent Date `7 f 0 S / �Ol —