OPHTE#15-5 Harnett founty Department of Public Health
23853
PERMIT# Operation Permit
New Installation "9� Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
�j PROPERTY LOCATION: V2
Name: (owner) W SUBDIVISION Qt:SMA \ Cera *1116 LOT #
System Installer: C>rsis Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well N 0 O feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
In Cmnpnma, win appmame norm lavonna uenem, m(wes, nmes Tor )ewaee uearmenr ana Ulapaam. ana an maroons or one improvement rermn ana eomormamn Atimortauon.
11
I eE0Psr2 I
'ASA i
2
V
G
19p,\R..Fev( fl2s-6
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation n
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box
❑ Pump ❑
Alarm ❑ F12O1-ine
❑ PWR Line
Fallowing are the specifications for
the sewage disposal system n. the above ca tinned property.
Type of system: El Conventional
� Other Pum 1 o EZ t -0w
Septic Tank: I000 gallons
Pump Tank: 1600 gallons
Subsurface `Noof
exact length
width of
depth of
Drainage Field�i
`'� of each ditch 0 feet
ditches feet
ditches 30"�G inches
French Drain Required:
Linear feet
Authorized State Agent V-4 �LS Date t I)'> I t 6
I S - 5 - 3-' Li)r,5