OPNTE# (4-S-3`1406 Harnett County Department of Public Health 24281
PERMIT # 0\ b 1!' Operation Permit
❑ New Installation ❑ Septic Tank -3
Nitrification Line ElRepa] Expansion
PROPERTY LOCATION.- aNlaOy
Name: (owner) V^ictsT'37W5 LJGPCI-N�N& < •tZtIL SUBDIVISION LOT #
System Installer: CL. , . ; No ASS Registration #
Basement with plumbing: ❑ Garage F-1Numberof Bedrooms Ste s�tt�.e•-' eiaSSc,
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well feet
System Type: -T—Li,' 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.
ims system am Deen mranea In comDilance Wen aooncame norm Umma ueneral )nmtes, doles toy stwaee Iremment dna minimal, and an conditions of dk hmororement remit and Lonswmon nDmdrlADDn.
D. )--6s FNooro 0- Q--, S, De- C) q- li)�D),y,F,c-V'0 Lie OP "a37C��
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the speifications for the sewage disposal system an the above captioned property.
Type of system: K, Conventional ❑ Other Septic Tank:
Subsurface No. ofa exact length width of
Drainage Field ditches of each ditch 15C feet ditches -3
French Drain Required` r feet
Authorized State Agent -aa� t6N 5 Date
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches -3005 -;L'-+ inches
I C-g-3�,60�