OPHTE# 11 -1; --Li 6 w-3 L Harnett County Department of Public Health 24505
PERMIT# 2-9313 �0 eration Permit
D New Installation Septic Tank E Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: u J-rsn—<LG)
Name: (owner) e �o'J(d- SUBDIVISION LOT #/-7 AJ -
System Installer: � s Registration #
Basement with plumbing: ❑Garag���N ber of Bedrooms 3
Type of Water Supply: ElN Community Public ❑ Well Distance from well feet
System Type: 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.
rtKrui LuNDIfIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewapdisposal s tem on the also a wptianjd property.
Type of system: ❑ Conventional fY Other Z1�JZ-�c .,�� Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 75— feet ditches feet ditches Z �� inches
French Drain Required: Linear feet
Authorized State Agettf _ X/Gr �� L /' L¢ /t„a„-7�— Date Ci'—
a
i