OPHTE# 1S - S -3i L0 Harnett County Department of Public Health 23972
PERMIT# a66a4 Operation ' Permit
NewInstallation %t Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
` PROPERTY LOCATION: Szo FLIL-N r"7 D rL
Name: (owner)JOSGN Stir v, re/+ iI SUBDIVISION NEvj NAm za*t LOT # Q>r. P .
System Installer. si N 9'Vty C.-, t o rJ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t O 0 feet
System Type: --VELb 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.
ims system nas peen msuneo in mmpnana wun appnaae morin uronna uenerai mases, nines mr nwage imasmenc no
I. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
n )]—)
anu mi commons of me
SigcLLi6�oa-
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.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal�s.Ystem on the above c tinned paaQerty.
Type of system: ❑ Conventional Other s= Z V LOv+ Qu mtJ Septic Tank s 00(3
Subsurface No. of exact length width of
Drainage field ditches 3 of each ditch S0 feet ditches 3
H2OLine ❑
PWR Line
gallons Pump Tank s030 gallons
depth of
feet ditches l$-Zi,0 inches
French Drain Required: Linear feet
Authorized State Agent �t Date a 16
� �- 5-31663