OP RHTE# /y-5 — 35fgar,Z Harnett County Department of Public Health 23368
PERMIT # Z9057 Operation Per it
Z New Installation Septic Tank Z Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:u s
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Name: (owner) d erg >�� �e.�.v,. SUBDIVISION LOT #
System Installer: De,wz, s YL-.2- (z Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 1 Type of Water Supply: ❑ Community J Public ❑ Well Distance from well feet
System Type: Z,5116 r ,4z— T' — G `d'2- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must co tact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North [arolma beneral Statutes, Rules for Sewage treatment ana uesposai, ana an conattions of the improvement rermit ana Lonstrucoon AUtnorization.
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sew# disposal system on the above captioned property.
Type of system: ❑ Conventional 2 Other ,r�ti Septic Tank: JDoa gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch / 5 ° feet ditches -' feet ditches o inches
French Drain Required: Linear feet
Authorized State Agent —�� - -' Date
14 -5 -34001 R (2) 14 -5 -34001 R (3) 14 -5 -34001 R (4) 14 -5 -34001 R (5) 14 -5 -34001 R (6)
14 -5 -34001 R (7) 14 -5 -34001 R (8) 14 -5 -34001 R (1)