OPHTE# tv - 1joVo Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 1 3
X, New Installation-"Z Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Mc..K~ot,C;.at..o
Name: (owner) SUBDIVISION S v r,ESt, v t,., LOT # 1
System Installer N ~L.,vm5,\T ~ Registration #
Basement with plumbing: ❑ Garage', Number of Bedrooms
Type of Water Supply: El Community Public ❑ Well Distance from well 1-00 feet
System Type: 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type o s Conventional Other F-Z- VI-GN4 Septic Tank: `00 gallons Pump Tank: gallons
Subsurface o. exact length width of depth of
Drainage Field ditches of ditch 5 0 feet ditches 3 feet ditches ca~ 3 d inches
French Drain Reauir4 fee
Authorized State Agent y.\ \'~.y~~ ~ e) Date `2 I1g11
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