OPHTE# 1j:5-y/ba3 Harnett County Department of Public Health 24822
PERMIT # ZS Yf3q Operation Permit
LJ'New Installation 2 �eptic Tank Q�it ification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: / v G I 4 Qa. 511 /V45;)
Name: (owner) kr t,., � 17c . SUBDIVISION _ A ,{r, on r LOT # 61
System Installer Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
It—
Type of Water Supply: ❑ Community Inc ❑ Well Distance from well r P feet
System Type:_ ?_65" � ��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.
this system has bNn instilled in compliance with applicable Nonh Carolina Genenl Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorisation.
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PERMIT CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
❑
D -Boz ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Convent onal fYOther
r P: �ovl Septic Tank
1 Di 5v gallons Pump Tank I :;[Sd gallons
Subsurface
No. of
exact length width of
qc'
depth of
Drainage Field
ditches
of each ditch feet ditches
3 feet ditches ZC� — 29 inches
trench Drain Required: Linear feet
f Date