OPNTE# Harnett County Department of Public Health 24147
PERMIT # as 5 343 OQeration Permit
U;P ew Installation L�ic Tank on line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Awc�v conA_ �r Lc A. �y lata JG (L A St Ai
Name: (owner) \,-3se>> c� Co�sl my u�� --� SUBDIVISION VA - :Zj Pc'nr JOT # 4—Y J
System Installer. �Registration #
Basement with plumbing: ❑ Garage E u*i of Bedrooms `/
Type of Water Supply: ❑ Community E?Iublic ❑ Well Distance from well feet
System Type: . 5`/y Types V and VI Systems expire in S years.
(In accordance with Table V a) Own st contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable North Carolina General Stamm, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conswnion Authomadon.
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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 G?'
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Cl D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sewage di posal system on the above captioned grope
Type of system: ❑ Conventional tether s I o a Septic Tank 13? 5Q gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch h 3G feet ditches 3 feet ditches
trench Drain Required: Linear feet
Authorized State Agent Date ma10 1 aC) �
PWR Line
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inches
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