OPHTE# 116-5 Harnett County Department of Public Health 24297
PERMIT # 2.)0 Y 3 Operation Permit
XNew Installation �Se tic Tank Nitrific tion line ElRepair E]Expansion
PROPERTY LOCATION:P%,,4F.s \1W
Name: (owner) I tray E—yd_-t+4G SUBDIVISION LOT #3
System Installer: =G MoBla- )Ao,e V1ov&o Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 eC5 feet
System Type: ;;;;= 4 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.
- >pm,,, ,gym ual, ,,,>wot„ iii mmpnanu w,m appn[aoie norm �amima ueneni somas, nines mr sewage vestment and Disposal, and all wntlibons of Me Improremem Permit and construction Authorisation
s 2LPA.'t_ t s+o�3E
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 ❑ H2OLine ❑ PWR Line
Folio in are the specifications for the sewage disposaostem on the above captioned property.
Type of sys conventional X Other Z Pt—ow Septic Tank: gallons Pump Tank: gallons
Subsurface o. exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches Qi0 —30 inches
French Drain Reouirrlh f pt
Authorized State Agent gz—.A5 _ Date 1\)3