OPHTE# Dq Harnett County Department of Public Health 23802
PERMIT # ZS'tSX Operation Permit
IX Neww Installation Tank C Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:&,245 dr b 5y�,IfaTl1
Name: (owner) ( , !YP �- �_RDIVISION LOT #
System Installer: F�o Gwwc.s._�TRegistration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: ❑Community 14ublic ❑ Well Distance from well feet
System Type: 23� c1a * 4-45- etul and VI Systems expire in S years.
(In accordance with Table V a) Owner must co ea epartment 6 months prior to expiratiln for permit renewal.
This system has been installed in compliance with dpnlireble North Carolina General Statutes, Rules for
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
30 /Z/43
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
conditions of the Improremenf Permit and Consmuttion Authorization.
O-Z;,T" To 34-1-74-2
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sa disposal system on the above captioned property.
Type of system: El Conventional
Conventional Other ZS��6�dZ J4--. Septic Tank: D� 6 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of'IGG
Drainage field ditches �- of each ditch �� feet ditches 3 feet ditches inches
french Brain Required: Linear feet ' M
Authorized State Agent< �� IL/�n.,� 9 Date fl — 2 3 '! 5�
15-5-36704 (2)
15-5-3n6 (3)
15-5-36704 (4) 15-5-36704 (5)
15-5-36704 (6)
15-5-36704 (7)
15-5-36704 (8)
15-5-36704 (9)