OPHTEJ-Harnett County Department of Public Health 23698
PERMIT# oZcg ,3 t ? Operation Permit
[;�Iew Installation Septic Tank �itri6cation Line ❑ Repair ❑ Expansion
! PROPERTY LOCATION:
Name: (owner) CJ 'zSUBDIVISION Aii A/J LOT # 8
System Installer: Ted-6,rc&,22,n Registration #
Basement with plumbing: ❑ Garage ❑ Dumber of Bedrooms 3
Type of Water Supply: ❑ Community 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
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rtKMII t.UNUIIIUM:
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional 2 Other Q),-) «C -k 4 �� a .�jPr— Septic Tank: 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch IoZ0 feet ditches .7 feet ditches 0 inches
French Drain Required: Linear feet
Authorized State Agenay �C'6� Date
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