OPNTE# Harnett County Department of Public Health 23615
PERMIT# / 0 eration Permit
Z New Installation Septic Tank Z Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: gy fkZs'
Name: (owner) Je < < s�� (v,�� GaR SUBDIVISION A,?v�-r,_�/c LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage E�r Number of Bedrooms 3
Type of Water Supply: ❑ Community [Y( Public ❑ Well Distance from well feet
System Type:sl 'r ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contac ealth Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwaa disposal system on the above captioned property.
Type of system: Eltional L1 OConventher 1:56/6 (Zkt>y c:R, -- :�9, sf — Septic Tank: / L> a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch U D feet ditches feet ditches ZU ' /8 inches
French Drain Required: Linear feet
'/'7
Authorized State Agent "'� _ �- �` ',�— Date Y�—
15-5-36045 (1)
15-5-36045 (2)
15-5-36045 (3)
15-5-36045 (4)
15-5-36045 (5)
15-5-36045 (6)
15-5-36045 (7)
15-5-36045 (8)
15-5-36045 (9)
15-5-36045 (11)
15-5-36045 (12)
15-5-36045 (13)
15-5-36045 (14)
15-5-36045 (10)