OPHTE#IS-S-'b'7rh Harnett County Department of Public Health 24301
PERMIT # a<b51 ► Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION: Si oa_a lrs R). a 6* RD
Name: (owner) RsZf d J2.o SUBDIVISION Tv rzc; 1 —TRaa LOT #
System Installer: Mfaeie5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms '$P I, r
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well c� 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.
ims syssem nas seen inszanea in compoante won appusame norm taroena beneml alatutes, Mules for sewage Irealment and normal, and all conditions of the Imororement Permit and Construction Authorization.
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rcnrin wnviinem:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:-X"Conventional ❑ Other Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainag'e� itches 91 of each ditch �� feet ditches 3 feet ditches a4-36 inches
French Drain Recxir ; `taaeat feet
Authorized State Agent Qa�\\5 Date
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