OP RHTE# 1 1 -6- 'a i-71 Q. Harnett County Department of Public Health
PERMIT # Operation Permit 22772
New Installation X, Septic Tank] Nitrification Line El Repair El Expansion
PROPERTY LOCATION: M lc�o w Z
Name: (owner) '14C- -t5—,anti Co 2.vC�-,-�® la SUBDIVISION �Is`�.t���.f a.cG LOT # a�
System Installer :moo rI Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 b 0 feet
System Type: o 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
rCltrlll LUNUI IUM:
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ,captio property.
Type of system: ❑ Conventional ,� Other C,�a th F.21- Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field -- ��itdit�s— of each ditch I2.0 feet ditches -3 feet ditches inches
French Drain Reauired-- n feet
Authorized State Agent C, __ Date