OPHTE# ) —5-4174/c Harnett County Department of Public Health 24855
PERMIT # aSa+fa Operation Permit
ew Installationtic Tank ion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1c) 93 P, E7•5 2d . (-$,I-- ),Vqr. �
Name: (owner) 2obb>e P6� SUBDIVISION LOT #
System Installer: C c3c;3 Registration #
Basement with plumbing: ❑ Garage ❑ Numb f Bedrooms
Type of Water Supply: ❑ Communiry clic ❑ Well Distance from well //13 feet
System Type: ab%v Types V and A Systems expire in S years.
(In accordance with Table V a) r Owner must contact Health Department 6 months prior to expiration for permit renewal.
niu ipmni na ueen instanea in comp Tana mm appllnoie norm tarouna oeneral statutes, aures for kwage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authoticadom
1. Performance:
IL 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 F_
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑
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Following are the specifications for the sewage disposal system on the above�caPtioned property.
Type of system: EI Conventional I�/-(
er 2c- 3 c, 1La Septic Tank: LA 60 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch %o feet ditches r
3 feet ditches
French Drain Required: Linear feet
Authorized State Agent Date
PWR Line
gallons
inches
a