OPHTE# \S--5--%s4s Harnett County Department of Public Health 23842
PERMIT Operation PeriTllt
New Installation )9 Septic Tank '�< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'DQ-
Name:
aName: (owner) Mc:: (Ee li—lorh ES LLC. SUBDIVISION C) Awa *f LOT # '9 6
System Installer: Ce o,6 GP+a-res Registration #
Basement with plumbing: ❑ GarageX Number of Bedrooms
Type of Water Supply: ❑ Common Public El Well Distance from well t feet
System Type: Types V and VI Systems expire in S 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 Cenral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and tonstruamn Auth snnnon
PERMIT CONDITIONS:
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal ,si stem on the above captioned property. �
Type of system: ❑ Conventional X Other 1. )ltT+N66tZ�g"eva Qscqaa.8 Wy,�Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field--ditthe of each ditch 5'2 1—) feet ditches 3 feet ditches inches
French Drain Require . Lineas�get
Authorized State Agent Date
Is