OPHTE# l�"$-4b3� Harnett County Department of Public Health 24845
PERMIT# Operation Permit
New Installation tic Tankrl (cation Line ❑ Repair ❑ Expansion
PROPERTY LO[ATION: 1 t0Q NG a
Name: (owner) Qx-,&.1\ SUBDIVISION LOT # 4
System Installer: sEDt,c ,l l Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms V_
Type of Water Supply: 13CY
Community P6 hl ElWell Distance from well feet
System Type: G -16%v te,& , l.�A S..c E�m Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner ust contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General States, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
PERM LUNDITIONS:
I. Performance:
II. 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 sewwage��d'sporal system on the above captioned .property.
Type of system: ❑ Conventional I; Other L'ZSeptic Tank: Ia&> gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch I C�'f7 feet ditches �_ feet ditches inches
French Drain Required: linear feet
Authorized State Agent �:f%c Date 1� 13c' aC l
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PERM LUNDITIONS:
I. Performance:
II. 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 sewwage��d'sporal system on the above captioned .property.
Type of system: ❑ Conventional I; Other L'ZSeptic Tank: Ia&> gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch I C�'f7 feet ditches �_ feet ditches inches
French Drain Required: linear feet
Authorized State Agent �:f%c Date 1� 13c' aC l
E .-