OPHTE# ��'S ''�O� G Harnett County Department of Public Health 24603
PERMIT # a.9 zi �i Operation Permit
New Installation 1K Septic Tank :Xn Nitrification Line El Repair F1 Expansion
PROPERTY LOCATION: COGS f A
Name: (owner) l C. c,2S SUBDIVISION Arsro LOT # Sq
System Installer: ()mss g 5—)crtL cw Registration #
Basement with plumbing: ❑ Garage1'K�r Number of Bedrooms
Type of Water Supply: EICommunity �I Public ❑ Well Distance from well feet
System Type: 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 mgditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
IV.
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1 House
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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 ❑ Nq%�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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 E.Z. 'F',,Ou Septic Tank: e D O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field- ditches 3 of each ditch 6 E ' feet ditches 3 feet ditches inches
French Drain Reouiced: _ Linear feet
Authorized State Agent iz&-AS Date
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