OPHTE# QQ--r> --C9 6o Harnett County Department of Public Health 2 0 5 2 5
PERMIT # D:S 03 I Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
_ PROPERTY LOCATION: R ~y 9,y Q10
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Name: (owner) J ~Mcn') SUBDIVISION ~J ro~~cy Pc, LOT # _
System Installer. -f:,S Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tCJa feet
System Type: -~L b 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.
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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 ❑ No'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. MP, c• -MF-E - 4 `4~ , . \"o'i;"-Es ! 2 ~ gcrEsSvn.E NEAn
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A Other pu`Sd Ca ~AMSEst Chu IC's Septic Tank: 100 O gallons Pump Tank: 1000 gallons
Subsurface No. of exact length LI-C) 4? t~ width of depth of
Drainage Field ditclfes~~ of each ditch )10 feet ditches feet ditches inches
French Drain Reauired_ inea et
Authorized State Agent Q. _ Date -~L, 110 0`1