OPNTE# s3 -5-"G47 Harnett County Department of Public Health 24703
PERMIT # 29 %tI Operation Permit
3 ew Installation �c Tank El—Titline ❑ Repair ❑ Expansion
PROPERTY LOCATION: c a j a 15 w.
Name: (owner) Q2 G5 sow -1i1- SUBDIVISION LOT At
System Installer:�m ; Registration #
Basement with plumbing: El Garage umber of Bedrooms —3
Type of Water Supply: ❑ Community Cmc EI-1—ell Distance from well 'mac F feet C'Zrcn Ir 4 Irl a --
System Type: z55 'tea c-6, -5-, s. t,�� 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.
[hiss stem has been installed in compliance with applicable Nunn Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construnion Authorization.
❑
D -Box ❑
Pump ❑
\
Following are the
specifications for the sewage disposal
system on the above captioned property.
I
\
\
r4-. :72z—�
Septic Tank: ✓ okr �, gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch l cjo feet
ditches feet ditches /6--3 inches
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— — — —
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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 fJ/
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional CY6ther
r4-. :72z—�
Septic Tank: ✓ okr �, gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch l cjo feet
ditches feet ditches /6--3 inches
French Drain Required: Linear feet
Authorized State Agent �� �'' . •lo_�tS Date 0A�{