OPHTE# i�-5�3 Harnett County Department of Public Health 25036
PERMIT # aG❑aO Operation Permit
New Installation �R Septic Tank �k Nitrification Line ❑ Repair ❑ Expansion
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� PROPERTY LOCATION: C.P. SzE.r xzx ��
Name: (owner) M„_s0W 1UV,LA NO(�C5 SUBDIVISION LOT #
System Installer. Ca_, ,r ; Registration #
Basement with plumbing: ❑ Garage )$' Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ZSI 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 compliano with applicable North Carolina General Statures, Rules for Sewage treatment and Disposal, and all conditions of the Improvement Permit and Conswttion Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation cc
IV. Operation:
maintenance and reporting.
V. Other. D-&* CIaC�C-'Eo P<Stme OF- lvg�ty1 (son
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on,Lh�e above captioned property.
Type of system: ❑ Conventional Other E Z Ya_Ow Septic Tank `10 0 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field diichesy of each ditch 160 feet ditches 3 feet ditches a:14 inches
French Drain Required: Linear feet
Authorized State Agent 't 4A5 Date