OP RHTE# I�-s-N�aa�2 Harnett County Department of Public Health 24686
PERMIT# 'L`ISiU Operation Permit
❑-lew Installation ET�Septic Tank E�—Aitrification Line ❑ Repair ❑ Expansion
PROPERTY LOICATION: 1631 Gc lCr;dSc bu cc . 2c1. csa I -
Name: (owner) (.tee ,)ogd 61iS5, c�� SUBDIVISION LOT #
System Installer. Sys m 4.1vim Registration # I a99
Basement with plumbing: ❑ Garage Ei-I!Vm�ber of Bedrooms 3
Type of Water Supply: ❑ Community public 0 Well Distance from well feet
System Type: 2.5%0 24.,1vc 6,o e\ 5 > 5 A-� __1ZE_ 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 system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Dispmal, 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.
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
❑ H2O1-ine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned rope .
Type of system:
❑ Conventional
13-�'Other fE--;r
Septic Tank: /Dew gallons Pump Tank: gallons
Subsurface
No. of
exact length
3
width of depth of
Drainage Field
ditches
of each ditch feet
ditches �L feet ditches Z8-3c� inches
French Drain Required: linear feet
Authorized State Agent / /L�/J>'Ql��� /6 Date c ct 3�oZo6 ��
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