OPHTE # 13 — 5 —3� '� t6 Harnett County Department of Public Health 2304.9
PERMIT Operation Permit
New Installation �, Septic Tank Nitrification Line F-1 Repair El Expansion
PROPERTY on
Osf%0 ► A C>O-
Name: (owner) �Cs>.J - aMES SUBDIVISION ®i X01 47 CL LOT #
System Installer: 0 a.% Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 16® feet
System Type: r 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.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E,-2 Z-0W Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch 3 of each ditch b feet ditches 3 feet ditches A inches
French Drain Required: ipwieet
Authorized State Agent Date >A
13-5 3����