OP RHTE# ts-5 WILi1IR, Harnett County Department of Public Health 23065
PERMIT # ����� Operation Permit
New Installation''( Septic Tank )�< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M PZ
Name: (owner) C.v SUBDIVISION A&roSzz LOT #
System Installer: i%o S�> :wN Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1Q) 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.
1 LI\I111 VVi \YII IVI\J.
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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-1201 -ine ❑ PWR Line
Following are the specifications for the sewage disposal system on„ jig above captioned pro ,,e�rr�,,�YY.' h
Type of system: El Conventional Other y M
�e 10 C''j�noS�G2 _�* ,� Septic Tank: t 0 ® l'J gallons Pump Tank: l O gallons
Subsurface o. of exact length width of depth of
Drainage Field ditches of each ditch 1 feet ditches 3 feet ditches i� ��l inches
French Drain Required: ear feet
Authorized State Agent Date ti-,► I