OP RHTE# I6 -5-391a32 Harnett County Department of Public Health 24852
PERMIT # 2 53 40 Oueration Permit_
["ew Installation C Septic Tank dation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 89 a ---
Name:
-- Name: (owner) la:yc -4-ex- sc rLC 14a&Az*. SUBDIVISION LOT # I t s
System Installer. c_c.a� Registration #
Basement with plumbing: ❑ Garage E;—Nfi�mber of Bedrooms 3
Type of Water Supply: ❑ Community El-+09�ic ❑ Well Distance from well ^ A feet
System Type: Q*i> tZeAi,yr -AbzK, ss. 22� Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Own must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable xorth Carolin4eneml Spates, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Furnit and tonstruction Authomanon
PERMIT CONDITIONS:
I. Performance:
11. 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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dis I system on the above capti_oned�Fro�erty.
Type of system: ❑ Conventional ter 1=� t=to, u LL1�s Septic Tank: r� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch CC.YD feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent Date
l sI51
I
35ia n.�vuc-tte"�
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PERMIT CONDITIONS:
I. Performance:
11. 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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dis I system on the above capti_oned�Fro�erty.
Type of system: ❑ Conventional ter 1=� t=to, u LL1�s Septic Tank: r� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch CC.YD feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent Date
i
e
0
I