OPJTE#—ii Harnett County Department of Public Health J
PERMIT # s6 Operation Permit
L New Installation IN Septic Tank Nit j cation Line El Repair I—] Expansion
PROPERTY LOCATION: -Le t Is. "a-
Name: (owner) co< G_5 y►L91N SUBDIVISION \A ,,,D1K)Q LOT # 1Z 6
System Installer: Es>p) V Gc> Gia- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public El Well Distance from well feet
System Type: to 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 applicable North Carolma General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement rermt and lonstruction Authorization.
�A56r'1 £
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tion roperty.
Type of system: ❑ Conventional Other \� t�t<, �2 Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface o. of exact length width of depth of
Drainage Field ditches , of each ditch aOO feet ditches -3 feet ditches tV 3d inches
French Drain Reauired: ® Line%Qeet
Authorized State Agent � __ � `� j Date