OPX33
HTE# �-3
te'/7Jt��—� Harnett County Department of Public Health 23980
PERMIT # Operation Permit
kNew Installation Septic Tank] Nitri,cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S N -`f %0 tJ hjA �.ov tri
Name: (owner) \V Awe1L Ro*-�t:3 *+c SUBDIVISION Qt Ps%,j (Zgn%)Nr. LOT # �-6—
System Installer. s'jss15 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community � Public EJ Well Distance from well S �8 feet
System Type: - Ca 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.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
uenemi nawtes, wins ror.vewage imatment ano mspomi, ano an conmuons ot me improvement rermn and eonstmmon mmomanon.
N
V
S Av A rJ N P11 -t
c7i.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yet ❑
If yes, see attached sheet for additional operation ca
V. Other.
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field
French Drain Required_\
maintenance and reporting.
Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
sewage disposal s captioned property.
Other EtObZ
Septic Tank: gallons Pump Tank gallons
exact length width of depth of
of each ditch a feet ditches 3 feet ditches a'i' IV inches
Z\ Linear feet
Authorized State Agent " -:%�\ R£yi5 Date
1G- 5-3�7 33