OP RNTE#i6'S'y� Harnett County Department of Public Health 9A-41 1
PERMIT # Operation Permit
New Installation 1K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: GuEga2y
Name: (owner) Ni oi�EF 1 io ,E s i e SUBDIVISION 0 war. o K. LOT # V5 �—
System Installer: E.0(z\ C G Ngo A exL- Registration #
Basement with plumbing: ❑ Garage �'K Number of Bedrooms h'1
Type of Water Supply: ❑ Community k
yp ppIy ty �( Public ❑ Well Distance from well LOQ feet
System Type: �r� ., 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 Stawtes, Rules for Sewage Treatment and Disposal, and all conditions of the Impmvemem Permit and construction Authorization.
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PERMIT CONDITIONS -
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Ny
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 abovg ca tion property.
Type of system:
El Conventional
X Other G1+pentb(art—iP'
Septic Tank: t aS'O
gallons Pump Tank: gallons
Subsurface
No, of
exact length
width of
depth of
Drainage Field
ditches
of each ditch Zli 0— feet
ditches
feet ditches I ''X�i inches
French Drain Re
I
aE�/ NaSUca-N� GILPOE.
Authorized State Agent Date t T l3 1) L