OPHTE# )I - s -q 176 Harnett County Department of Public Health 24834
PERMIT # a ` 5 Operation Permit
ED -1116 Installation TankItrification Line ❑ Repair ❑ Expansion
1 PROPERTY LOCATION: NAC) C,,'cwr Vc,xw, 2A. L�2
Name: (owner) Qec� Shy lliC, y. — SUBDIVISION LOT # 3A
System Installer: 9bL-c a C,c Registration #
Basement with plumbing: ❑ Garage E�1,4umber of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ell Distance from well /4 feet
System Type: a.S 5'c r fl-& r A- :r A\ Ss . 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.
This system has been installed in compliance with applicable North Carolina General Salutes, 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.
It. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage dis Isal system on the above captioned property.
Type of system: ❑ Conventional er f -L3 b Chc. 6-,,b— ' Septic Tank: I V gallons Pump Tank: gallons
Subsurface No. of exact length T— width of depth of
Drainage Field ditches 3 of each ditch I UrntO feet ditches feet ditches Pf4 inches
French Drain Required: Linear feet
Authorized State Agent �� Date 0Y -q—