OP R,, Harnett County Department Health 23061,
PERMIT # �°��`t°1 Operation Permit
New Installation X Septic Tank )< cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0--L-FN Sw'h�
Name: (owner) �Jc®,v�t�j 4MES SUBDIVISION MQv^s 4c_:_t.. LOT # 9VA
System Installer: 14; -,,fLo r Registration #
Basement with plumbing: ❑ Garage �° Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1(50 feet
System Type: _ c, 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
HERMIT LUNDITIONS:
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 ❑ I o
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 captioned property.
Type of system: ❑ Conventional Other EZ ''rvv3,i: Septic Tank: VOO 0 gallons Pump Tank: gallons
Subsurface exact length width of depth of
Drainage Field ditches of each ditch 11.0 O feet ditches _ feet ditches IT inches
French Drain Required: _�
Authorized State Agent `!� — ���'�``� ��� 4% Date
1.3-5- 31013