OPHTE# 11-5-41(/4 Harnett County Department of Public Health 24825
PERMIT # a rYto-4 Operation Permit
MErt,
Ca—New Installation [optic Tank 9—Ili rification Line El Repair ❑ Expansion
_14c -i r e t}-W—a;CL'aPROPERTY LOCATION: AO s.bcnazc.� Gyv r l 2a / s tss;�
Name: (owner) 6T.A� SUBDIVISION LOT #
System InstallerRegistration #
Basement with plumbing: ❑ Garagef�—pR edroo
Type of Water Supply: ❑ Community ublc if )0451 feet
System Type: Q Sim /1c,A..c.kma 5, s �Ti;%-- 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 appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Alnhoriri ion
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 211
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for
the sewage sal system on the above captioned property.
Type of system:
❑ Conventional
L�',� /%/ o,a .
Septic Tank: y, gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
3 of each ditch IUD feet
_
ditches _� feet
ditches a'�; inches
french Uram Required: Linear feet
Authorized State Agent / Date is Baal aC>l�
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41
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