OPHTE# )cl- � Harnett County Department of Public Health
PERMIT # Operation Permit 22786
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t `Nyca
Name: (owner) 0 tr'n�--5 SUBDIVISION Qs> a3 Poo 4— LOT # 2.S
System Installer: W a-tr4G oNEs Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ! OCR 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 been instaneb in compnance with applicable North Larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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rtKMIl LUNUII1UNS:
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 ❑ N20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the a ove cap tied property.
Type of system: El Conventional Other CxA Septic Tank: {Q)a(O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch a0 feet ditches 3 feet ditches inches
French Drain Required: _�_ Linear feet
Authorized State Agent -Qk"� v- --A5 _ _ Date 11%0