OPHTE# 1~7-5 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 2 0 7
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1',)il-_7
Name: (owner) 'Yn t~ cUV a Q~ SUBDIVISION 'S-i N6 r, Y o, 016 -LOT # 103
System Installer: GQ57~.ds"5 ~t0c'VQ1v-z 0- Registration #
Basement with plumbing: ❑ Garage ' Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 O d 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.
ims system nas peen mstanea in compliance wan applicable north laronna beneral statutes, rules for sewage treatment and
and all conditions of the
Permit and Construction Authorization.
k10 U 5C
WA
rtKMI l IUNUI I tUNI:
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other QU,*e4 _78 Y,Z N7L'Ju Septic Tank: LOCO ^ gallons Pump Tank: 103 gallons
Subsurface No. of exact length _ width of depth of
Drainage Field ditches of each ditch 2-~s feet ditches 3 feet ditches 1`9 inches
French Drain Reauire&_-, C~ ezar
Authorized State Agent ~Vy` RNs Date