OP RHTE# /3 - ,�Zzg3/Z Harnett County Department of Public Health 23084
PERMIT # a-? �o `I 7 Operation Permit
Zr New Installation Se tic Tank Vitrification Line El Repair El Expansior
l PROPERTY LOCATION: ���5.
Name: (owner) C ket f M�J LL C SUBDIVISION �a �c�f LOT # J 0
System Installer: G_ C�'r-lvz._,Zu Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 17Z7 J 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.
Ina system has been installed in
with applicable North larolma beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew disposp0f)�e system pn the above captio�neo property.
Type of system: ❑ Conventional Other 10 Qj y (duo. --yes' Septic Tank: //000 gallons Pump Tank: !0'3'0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch �� feet ditches '7 feet ditches 18 inches
French Drain Required: Linear feet
Authorized State Agent 42 rc�� ZU �' 1` V Date z �r
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