OPHTE# O`5-5- crass I Harnett County Department of Public Health 21322
PERMIT Operation Permit
New Installation Septic Tank ❑ RepairN Nitrification Line ❑ Expansion
PROPERTY LOCATION: PoNoEaos>"
Name: (owner) M-111C parN;--~ LLC. SUBDIVISION C- QOLlqr• SEC~SdNs LOT # 3,_
System Installer "TE o RN rN Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Ll
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1.0 o 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.
items system has been installed to compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captione roperty.
Type of system: ❑ Conventional Other C\i o.a,aE.cL C0v Septic Tank: t d y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche of each ditch feet ditches 3 feet ditches aL~- 30 inches
French Drain Required: ar feet
Authorized State Agent Pr--* Date 31A
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