OPHTE# I(, 5 - ywyc Harnett County Department of Public Health 24830
PERMIT # 25,945 Operation Permit
[ —Ne lhstallation 2-Te—ptic Tank 9-1rit—rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_1 =f 3 R 3 r//ted 2.1 . l 5 i ja )
Name: (owner) Mc.66 I ova. GiA.& e.n.�, SUBDIVISION a;,,e LOT # 9a -
System Installer: N.. Registration #
Basement with plumbing. ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community [7.-11`9511ic— ❑ Well Distance from well '"A feet
System Type: a 6"5: / / _ 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.
Inn system has been Installed In compliance with appl¢able North fantlina beneral Stamus, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
if %v M1r 4q. T Ic
2c49A 12
A t -E.4
1t Oµ w ? Linc Ghw.t6cr
SG(6) Id
r I
I
1151 I" 1351
3x52
S Fs�
910
13A L L . T`L V> r,
rcnnn sunvulvns:
1. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
III. 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
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned prope' .
Type of system: ❑
er — [xmloe_c--
Conventional Ge04
Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches S of each ditch 56 feet
ditches 3
feet ditches as inches
trench Drain Required: Linear feet
Authorized State Agent Date III 15 /yvt 4—
v