OP RHTE# 11-5-W6192 Harnett County Department of Public Health 24714
PERMIT # Z95Nb Operation Permit -
el_+N�w Installation Septic Tank 9--NTTI [ion Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: mc.nn 2c c1 C s t 9,63–)
Name: (owner) 5l,nul.vr Lli ag z51A5 SUBDIVISION LOT # _3
System Installer Registration # :Z :3 s
Basement with plumbing: ❑ Garage M -119m of Bedrooms 4/
Type of Water Supply: ❑ Community 2'Public ❑ Well Distance from well — 4 feet
System Type: ZS�"' Ar A, ice,, S 5. L� Types V and A Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
. _...... .......... —
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 -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disoosal system on the above captioned property.
Type of system: ❑ Conventional 90ther Septic Tank: (ate gallons Pump Tank: %CX`X�) gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch CC> feet ditches 3 feet ditches Q3 inches
French Drain Required: Linear feet
Authorized State Agent Date I" /A 6 / -Aci I t
wr