OPHTE# 1-4 -s - 4 113 Harnett County Department of Public Health 24693
PERMIT # ZG 4G5 0 _eration Permit
New Installation ff Septic Tank -ET Gitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3Czl tel- 3,ela, lz�d, Cgs 1;1r2
Name: (owner) &-,,A %- SUBDIVISION � LOT #
System Installer: 61vi5 G.«to.t Registration #
Basement with plumbing: ❑ Garage limber of Bedrooms H
Type of Water Supply: ❑ Community ❑ Public el well feet
System Type: z , 9" s 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.
cors system has been installed in compliance with applicable North Carolina General Statutes, Rules far Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authormadon
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YtRNII LUNUIIIUNS:
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 ❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewagedais osal
system on the above captioned property.
Type of system:
❑ Conventional r
PJ -/ c- ic,A .4� Z
Septic Tank: / et SO gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches `a
of each ditch I O feet
ditches 3 feet ditches Rd inches
erench Uraln Required: Linear feet
Authorized State Agent ���� Date