OPHTE# Ij-5-NI¢&5 Harnett County Department of Public Health 24826
PERMIT# '2gSgl Operation Permit
Q-- ew Installation k r Itr�ion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 4gs c- k,ok C 52 a 5µ
Name: (owner) 5;vneeE.xe Nr, olds SUBDIVISION LOT #
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System Installer. Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community ❑ Public L?Wi11 Distance from well feet
System Type: '2 591& At aS e L .. 5 - --Z- 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 Stamm Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLims ❑ PWR Line
Following are the specifications for the sewage disco al system on the above captionedyrroo erty.
Type of system: ❑ Conventional ❑iter �y i % : TI Septic Tank: 1-1543 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 1 020 feet ditches 3 feet ditches ey7 inrhec
French Drain Required: Linear feet
Authorized State Agent Date I III 4 / �j
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