OPHTE# Harnett County Department of Public Health 21 4 4 3
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: MPAy,'~,5 P7.0
Name: (owner) MP,94 MnC,l. OEv W -r- SUBDIVISION f`~ ELV7o q g> LOT #
System Installer. 17-z ?>rao vw rv Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms - 2
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: a 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 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.
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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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the hove captionetk property.
Type of system: ❑ Conventional Other C.hs-~t~ w~'A)) Septic Tank: 1000 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches --a each ditch ~O feet ditches 3 feet ditches Q!Ainches
French Drain Reouired: \ Mina
Authorized State Agent Date