OPNTE# A (e - 5.3 5006 Harnett County Department of Public Health 24407
PERMIT # ZRO(S 0 eration Permit
ew Installation Septic Tank L;i itdiication line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ \oarsn, At- ((,Wjlva,�Ce fl,�• 5(t ILJ'L9)
Name: (owner) what, 1ttc. SUBDIVISION skJerQor& LOT #Imo_
System Installer. K knor QlQfibsnRegistration #
Basement with plumbing: ❑ Garage EiAmber ofiedrooms 4—
Type of Water Supply: ❑ Community E14ublic ❑ Well Distance from well feet
System Type: 2�5 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.
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 persons and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage sal system on the above captioned property.
Type of system: ❑ Conventional Z 5 %v 4k4a, Fz r'/r o Septic Tank: 17- SV gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch (e V feet ditches 3 feet ditches Z0 y ter inches
French Drain Required: Linear feet
Authorized State Agent °� ' Date 0! 1 c� t I F q-
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