OPHTE# ` Harnett County Department of Public Health
PERMIT # ci�')DS�1 Operation Permit 22501
New Installation )�, Septic Tank,,. Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C),Ea� )Lj_s Q,D
Name: (owner) Q M yU�Rj SUBDIVISION LOT #
System Installer: e ri c� Sa_gyNc, _ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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 oeen instaneo in compoance wim appucame norm T.aronna aenerai matutes, naves Tor sewage Treatment ana Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capf ned property.
Type of system: ❑ Conventional Other ctip�eRr2,QL rQ'-1�� Septic Tank: 1 ®0® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches i of each ditch X14 feet ditches feet ditches alli inches
French Drain Required: s r. ..Linn 4et
Authorized State Agent Date __ AjtiIl2