OPHTE# Harnett County Department of Public Health 24865
PERMIT #--a -1`1 Operation Permit
Q -'C Installation E;Fep c Tank �ation Line ❑ Repair E]Expansion
PROPERTY LOCATION: ___r G��'.�snoon Gl (005(,V 1(dJJJjjjYJ3y2 is)o
Name: (owner) C.O(4Lrt-, 14r) et, ,L, SUBDIVISION �K,8 l,A,5 LOT #y(�
System Installer: On,— 1' Registration # -TT
Basement with plumbing: El Garage CJ N m er of Bedrooms —3
Type of Water Supply: ❑ Community Ci-PuR_c ❑ Well Distance from well j' k het
System Type: 3� 11�Ave_iit;, 4 c !22Z Types V and VI Systems expire in S 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 applicable Nonh Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Communion Authorization
PERMIT CONUIIIUM:
I. Performance:
It. 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 di sal system on the above captione erty. ,'
Type of system: ❑ Conventional [her YS (.isLyyL�ecS Septic Tank: ,� gallons Pump Tank: l C.( gallons
Subsurface No. of exact length�� j width of depth of >�
Drainage Field ditches of each ditch feet ditches 3 feet ditches" inches
french Drain Required: Linear feet
Authorized State Agent Date 09zUi;;/�Qj�,
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PERMIT CONUIIIUM:
I. Performance:
It. 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 di sal system on the above captione erty. ,'
Type of system: ❑ Conventional [her YS (.isLyyL�ecS Septic Tank: ,� gallons Pump Tank: l C.( gallons
Subsurface No. of exact length�� j width of depth of >�
Drainage Field ditches of each ditch feet ditches 3 feet ditches" inches
french Drain Required: Linear feet
Authorized State Agent Date 09zUi;;/�Qj�,
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