OP RNTE# I ,s-ytr 52 Harnett County Department of Public Health 24704
PERMIT# 7-`r2aC' Operation Permit
Clew Installation optic Tank a—Witrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ZVy r, Ac: Ln. Cm�Q&� m,* a P,1 'U . sic is-)
Name: (owner)-T"sory B (.orrre w: ii s SUBDIVISION LOT #
System Installer. K rcc.kti a1 'OL.Ca Registration #
Basement with plumbing: ❑ Garage ❑of Bedrooms
Type of Water Supply: El Community Nu❑ Well Distance from well feet
System Type: 2 5> t �r�, 5 i s i 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
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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.
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage ddii Posal system on the above captioned roperty.
Type of system: ❑ Conventional ❑cher Septic Tank a 50 gallons Pump Tank: gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches of each ditch C6Cfeet ditches 3 feet ditches ad inches
French Drain Required: linear feet
Authorized State Agent Date 10 / 1 :7 / 20r+