OPHTE# ) - s-qlrL2 Harnett County Department of Public Health24691
PERMIT# 193'10 Opgration Permit �/
ew Installation Cfeptic Tank 2' NMrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Z66i 6�bec�, cH, /t.J ( sic a7,cS1
Name: (owner) 01;I e SUBDIVISION LOT #
System Installer: Lccr Srwr Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms ^'�•'ti
Type of Water Supply: ❑ Community Blit ❑ Well Distance from well feet
System Type: CWvenj,'&nn/ Si r- ---25E7-A 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 General statutes, Rules for Sewage Treament and Disposal, and all conditions of the Improvement Permit and Commmon Ambaruation
PERMIT CONDITIO
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 ❑ _
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 1]�-It—her -';-/ ;v (.lyes « Septic Tank:
Subsurface No. of exact width of
Drainage Field ditches f of each ditch t OCA feet ditches _
H2O1-ine ❑ PWR Line
I c�c.a6 gallons Pump Tank: gallons
depth of
3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent w;ee- Date aetaoir
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