OPHTE# (1-s-yis9y Harnett County Department of Public Health 24841
PERMIT # 41 Operation Permit
EJ --New Installation L?-S�eptic Tank (cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: A< 2t_ 5q-
Name:
¢Name: (owner) KEcu^X Andrea S a k. SUBDIVISION LOT #
System Installer. Lc rr4 sI`w.rk t Registration #
Basement with plumbing: ❑ Garage ❑ Nu�m -of Bedrooms
Type of Water Supply: ❑ Community a Public ❑ Well Distance from well ~ feet
System Type: 'Q.15o'K, 44'kwu"A s zt, 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 been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement permit and Constructian Authorization
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 -Box ❑
Pump ❑ Alarm ❑
112O1-ine ❑ PWR Line
Following are the
specifications for the sewageedd sal s
stem on the above captioned property.
Type of system:
❑ Conventional Cd�Other2
�c� Septic Tank: f a,��
gallons Pump Tank_ gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches :3
of each ditch feet ditches J
feet ditches '3f> inches
French Drain Required: Linear feet
Authorized State Agent