OPHTE# "dab Harnett County Department of Public Health 23382
PERMIT # 0 eration Permit
New Installation'XI Szql"aC-
TankX itrification Line El Repair El Expansior
PROPERTY LOCATION: Name: (o
wner) Y5,j SUBDIVISION S. V r,,5 s nc LOT #
System Installer: iP,,,4 c ii— Registration #
Basement with plumbing: El . Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community lik Public ❑ Well Distance from well feet
System Type: 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional V Other E-2- 'Z7ircv•rr Septic Tank: i0bG gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches
French Drain Required: _ ' ear feet
Authorized State Agent \`'�`' S� v0t,5 Date
PWR Line
gallons
inches
et
P
V \
P
1
o
f�'
x
i
PERMIT CONDITIONS:
I. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional V Other E-2- 'Z7ircv•rr Septic Tank: i0bG gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches
French Drain Required: _ ' ear feet
Authorized State Agent \`'�`' S� v0t,5 Date
PWR Line
gallons
inches
13--5 - 32.o5a,