OPHTE# j{a���� Harnett County Department of Public Health
PERMIT # Operation Permit 22550
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) S(��jy \A o�.�— SUBDIVISION igs t °�r"P s LOT # IAL
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Lj
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 4 ®o feet
System Type: _1 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtKMII IUNUIIIUN):
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: [I C entional Other P Q� 3 0 Z —C) Septic Tank:
Subsurface No. of exact length width of
Drainage Field d'ttcches of each ditch feet ditches
French Drain Required: \__
H2OLine ❑
Authorized State Agent ` V vk__7> _ Date 10
PWR Line
gallons Pump Tank: V® 0 t) gallons
depth of
feet ditches} inches