OPHTE# \ rS-5-3MHarnett County Department of Public Health 23761
PERMIT # Operation Permit
New Installation Septic Tank trlfication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: RnssE2 �rrCmp,,, T
Name: (owner) \AEPY&Q, �Aor�GSc- SUBDIVISION 91s1mv%,4 Grn$wt; LOT # °LTi
System Installer: C)ra s e, En o Registration #
Basement with plumbing: ❑ Garage 1K Number of Bedrooms 3 a
Type of Water Supply: ❑ Community ')!� Public ❑ Well Distance from well 5 00 feet
System Type: j b 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 Summit, 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.
ll. 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 Cl Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A, Other Pttcat- To E. 7— V]_tjyy Septic Tank: 1000 gallons Pump Tank: 100 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S s'O feet ditches 3 feet ditchesM !;Pmj inches
French Drain Required: Linear feet
Authorized State Aunt�t� ��� lc�'-) Date
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 Cl Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A, Other Pttcat- To E. 7— V]_tjyy Septic Tank: 1000 gallons Pump Tank: 100 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S s'O feet ditches 3 feet ditchesM !;Pmj inches
French Drain Required: Linear feet
Authorized State Aunt�t� ��� lc�'-) Date
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