OPHTE# -�i- -Sj -O 41 Harnett County Department of Public Health
PERMIT # OTZ1 S Operation Permit 2,3013
Z' New Installation Z Septic Tank Z; Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:, iW'7- %
Name: (owner) k4&, SUBDIVISION LOT # 2
System Installer: eM77 , 5 ?t-r,(- L/�/qAO Registration #
Basement with plumbing: ❑ Garage P1,4 umber of Bedrooms
Type of Water Supply: El Community L-T Public ❑ Well Distance from well feet
System Type: Z % fl-s L 5 �— 7E,ier_ �[Z el. C- 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.
YtKM11 IUNUIIIM:
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the s disposal system on the above captioned property.
Type of system: El ewa Conventional Other 15% til -bVf aj nr 5 Septic Tank: C% 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches °
g � feet ditches -- /� inches
French Drain Reauired: Linear feet
Authorized State A ent "% MJ62� Date 17-- 1 -1- -15
13 -5 -31906 (1) 13 -5 -31906 (2) 13 -5 -31906 (3) 13 -5 -31906 (4) 13 -5 -31906 (5)
13 -5 -31906 (6)