OPNTE# la - s -ylcv,6 Harnett County Department of Public Health 24694
PERMIT# 01619,$1 ODeration Permi
Er-41eW Installation Ea'leptic Tank ❑-66fication line ❑ Repair ❑ Expansion
PROPERTY LOCATION: i9e R��� Pr Ccnc'sEK t;�✓it��
Name: (owner) A—:1 r_ rte, SUBDIVISION LOT # Sv yid
System Installer: t c"M G Registration #
Basement with plumbing: ❑ earage umber of Bedrooms 3
Type of Water Supply: ❑ Community M-lublic ❑ WellD.nce from well feet
System Type: 5 0 � ! ,, k,", Types V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
This svimm has been Imts6d in mmnli.nrr with annlinhl. Nnnh Cam im n...nl tnmu. Md., Mr hues. Tmem.n, end nu.—i ..A .II —Ai.;- .1 A. I.nn.......... D...d...A r......w.. Au.l...d...:...
rtKrui wmmtum:
in5{c,ll t>c¢P 10 5ix.�lto�
I. Performance: System shall perform in accordance with Rule .1961. ;r, 'd4tA +o a-Ae Ce
II. Monitoring: As required by Rule .1961. bt wf� 4 rov^J 4uroc (Alt Iewe\�
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No _ C_V,'hcd .o:tk t4,5e, -.-.A kc '
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwageed' tioned
osal system on the above captioned Property.
Type of system: El Conventional LXOther /"'moi Jc.�:i1F- Septic Tank: /UGC gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ��J feet ditches feet ditches �/e inches
French Drain Required: Linear feet
Authorized State Agent Date
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rtKrui wmmtum:
in5{c,ll t>c¢P 10 5ix.�lto�
I. Performance: System shall perform in accordance with Rule .1961. ;r, 'd4tA +o a-Ae Ce
II. Monitoring: As required by Rule .1961. bt wf� 4 rov^J 4uroc (Alt Iewe\�
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No _ C_V,'hcd .o:tk t4,5e, -.-.A kc '
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwageed' tioned
osal system on the above captioned Property.
Type of system: El Conventional LXOther /"'moi Jc.�:i1F- Septic Tank: /UGC gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ��J feet ditches feet ditches �/e inches
French Drain Required: Linear feet
Authorized State Agent Date