OP RHTE# 11 -5-` 1(-P�,Z Harnett County Department of Public Health 24715
PERMIT # Zq Sr65 Operation Permit
lew Installation �ic Tank ion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rJ1 nn 2 A C 5rc r�5-531
Name: (owner) 5, t SUBDIVISION LOT # 54 -
System Installer: = Registration # 377c S/
Basement with plumbing: ❑ Garage M um f"Bedm
roos
Type of Water Supply: ❑ Community 9-Tublic ❑ Well Distance from well feet
System Type: 7-55/' -;� 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.
1. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ H2O1-ine
❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captio nedrly.
Type of system:
El Conventional
r _ 4— f>
Septic Tank: /;I 5r- gallons
Pump Tank: ��-� gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
GJ of each ditch aC3 feet
ditches feet
ditches aC> inches
French Drain Required: Linear feet
Authorized State Agent /���5 Date -;I&t`t
I