OPHTE# ►-)-5-I.10'Aq'9 Harnett County Department of Public Health 24872
PERMIT# Z0ik3L4 Operation Permit
New Installation V Septic Tank �X Nitrification Line ❑ Repair ❑ Expansion
(� t PROPERTY LOCATION: "ii,- moN Gn.ove 9,o
Name: (owner) SarseE.a� �rdA+OcoN �)Ao,.+-aM SUBDIVISION LOT #
System Installer: C; a . erL Sin s I G Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms L
Type of Water Supply: ❑ Comm uni Public ❑ Well Distance from well feet
System Type: o 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.
[his system has been installed in compliance with appliable North Carolina cental Statutes, Rules for Sewage Treatmem and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NON
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
Type of system: ❑ Conventional
sewage disposal system on the above cap tin'ned pro
Other CrtPwsCa- �pe c 3� lito�
Septic Tank: 10017 gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches. S
of each ditch a.4d feet
ditches_ feet ditchesinches
French Dain Required:
Linear feet
Authorized State Agent C— A5 Date