OPHTE# Irl -S-4M43 Harnett County Department of Public Health 24597
PERMIT # a`� Operation Permit
New Installation '�K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
M ' E 1�o cgcs LLC., PROPERTY LOCATION: btu
Name: (owner) �- SUBDIVISION LOT #
System Installer. C-' ooNE G PQ T,.s[fL Registration #
Basement with plumbing: ❑ Garage �' Number of Bedrooms 3
Type of Water Supply: ❑ C!2!2±nitt �14 Public ❑ Well Distance from well feet
System Type: ` 1")Z 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.
Inn 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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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage dispop$aI system on the above captioned property.
Type of system: El Conventional Other ` AO� \P1 C GARME&% 4-11i N90i Septic Tank: 1 C) 0 0 gallons Pump Tank 000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ) of each ditch feet ditches 13 feet ditches 30 inches
French Drain Required: Linear feet
Authorized State Agent t - -, Date I I ui 1
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