OPHTE# ) 7-5-40-1 Sy Harnett County Department of Public Health 24727
PERMIT # ag411 Operation Permit
New Installation X Septic Tank 6)Wp Nitrification Line El Repair ❑ Expansior
_ PROPERTY LOCATION: Etv4.eY. moyyN Q:j
Name: (owner) MvsE9 I SUBDIVISION LOT # 1A
System Installer: 1SL-L0-,- CQoG G0HON,4 C Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: �c 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 Permit and Conswtlion Authorizanon.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional opera
IV. Operation:
Other.
1961.
conditions, maintenance and reporting.
❑ 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 Z-. Septic Tank gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -2�r:0 feet ditches 3 feet ditches -Z;4 inches
French Drain Required: Linear feet
Authorized State Agent 'f :!! ~ 35 Date
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