OPHTE# � I- 5- a.LC�� Harnett County Department of Public Health
PERMIT # a Operation Permit 22755
New Installation K Se tic Tanl(X Nitrification Line ❑ Repair E:1 Expansion
PROPERTY LOCATION: I �wvGAt Wo " e—P
At,--;,Name: (owner) McSn Ss%-'F S;' M,gC SUBDIVISION LOT #
System Installer: ! &o,,4 j Registration #
Basement with plumbing: ❑ Garage ❑ *tbe s Ll Sy -N-0L cc-05
Type of Water Supply: ❑ Community `R Public ❑ Well Distance from well toC) feet
System Type: 7;� 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 lonstruction Authorization,
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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 ❑ Nov"
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OUne ❑ PWR Line
Following are the specifications for the sewage disposal system on the abo a captionqyd property.
Type of system: ❑ Conventional Other C tiyeva,arQFw2 'k�f Septic Tank: t® gallons Pump Tank: gallons
Subsurface No. of exact length d width of depth of
Drainage Field mitres —, �� of each ditch ) feet ditches feet ditches ad" ® inches
French Drain Required:
Authorized State Agent ��� �`\��`�� Date ba 0 2--