OPHTE# )),)-``1)'517 Harnett County Department of Public Health 19 919
PERMIT # 9359 { Operation Permit
New Installation Septic Tank ❑ Repair Q~Nitrification Line ❑ Expansion
PROPERTY LOCATION: co N~
Name: (owner) ~Nv-
Y SUBDIVISION 1\\_ LOT #
System Installer. 0 Sr a j, c e, Registration # _ ?2d 1
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water wy: ❑ commupiq Public ❑ Well Distance from well feet
System Type: I A Lk 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 mstM in complimce with appktabk North Carolina General Statutes, Rules for Sewage TreamwK yd Disposal, yid 21 cor,60 m of the lm ovement Permit and Comauctim Audmanom
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PERMIT cOND(TIONS:
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.
Following are the.sped tions for the Fewe disposal system on the above captioned property.
Type of system: conventional Other Size of tank: Septic Tank: gallons Pump Tank: V allons
Subsurface No, of exact length width of g
Drainage Field ditches. II depth of q
of each ditch V J feet ditches feet ditches inches
French Drain Required: Linear feet
14
Authorized State Agent Date ~o~