OPHTE# 11-6Lgy>dl03 Harnett County Department of Public Health 24170
PERMIT # 'a959.3 Operation Permi ��
ew Installation eptic Tank �Nrtrdlcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 11 q q I " C, 24
Name: (owner) Q<ioec-4-1- V -c c -en SUBDIVISION LOT #
System Installer: 0&' s 5 r c K\ Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community U-�ublic ❑ Well Distance from well A feet
System Type: a15 % !le 1�c L:on ! 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.
min system hat Wen msalled In compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ —D -Box ❑ Pump ❑ Alarm ❑ 111201-ine ❑ PWR Line
Following are the specifications for the sewage Isposal system on the above captioned�rope_rty.
Type of system: ElConventional [er VI z4& G1,n. Septic Tank: L(!)CY�> gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch \ 00 feet ditches 3 feet ditches c;�) inches
trench Drain Required: linear feet
Authorized State Agent Date C),.3 tog I go,�