OPHTE# t4—5-YICYI Harnett County Department of Public Health 24718
PERMIT # Z ri 5G3 Operation Permit
CJ-le—w Installation [T�Septic Tank �rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:013{ 6!V-45{- Gra. (52 c4e?�f)
Name: (owner) Kp.ey. SUBDIVISION LOT # S
System Installer. -r MMU co'o-t Registration #
Basement with plumbing: ❑ Garageum�btr of Bedrooms 3
Type of Water Supply: ❑ Community El-Fublic ❑ Well Distance from well ^ feet
System Type: _ 7-5 u n+.a.,�r<.:..,� Szs 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.
in npmm nu oeen mstaum in compliance wish applicable North Carolina General Statute% Rules for Sewage Treatment and
•'C.FaA ,1 4rt,fl
n ?� t
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
and all conditions of the Improvement Permit and Construction
Subsurface system operator required! Yes ❑ No G?"
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ _
Following are the specifications for the sewage_di3posal system on the above captioned property.
Type of system: ❑ Conventional �Dther �� Septic Tank:
Subsurface No. of3 exact lengthwidth of
Drainage Field ditches of each ditch U feet ditches _
French Drain Required: Linear feet
Authorized State
��1f� t.,�v re- aer:KS St•��-.'t SG
�2M ser ��c F: GeA
Asp -
6e dfu.t�5 Shn�a�
d ; .aa�i,.� ...ate F� •v
'f -f 1' e_ 'Ar' '
H20Line ❑ PWR Line
gallons Pump Tank: gallons
3depth of
feet ditches Qq -16 inches
Date /aicsr3
ff
Ir
FEEL
M