OPNTE# Harnett County Department of Public Health 25084
PERMIT # SO Oa \ Operation Permit
New Installation �R Se tic Tank X Nitrification Line ❑ Repair ❑ Expansion
p PROPERTY LOCATION: o4Ltaa �02
Name: (owner) Sv. Vorw M65gi G SUBDIVISION LOT #
System Installer: Lv,qrLy SY.tta2P6 Re istration #
Basement with plumbing: El Garage 11 Number of$edreerN s� Pa.eV�3 2
Type of Water Supply: ❑ Community 15<tublic ❑ Well Distance from well feet
System Type: 7EZ 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.
Ibis system has been installed in compliance with appliable North Carolina General Starnes, Rules for Sewage Tmamient and Disposal, and all conditiom of the Improvement Permit and Connnidon Amhoriudon.
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PERMIT CONDITIONS:
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 ❑ No)9�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. 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 'Tscak CrN-YJ' Septic p Tank: l eGG
gallons Pump Tank gallons
Subsurface
Drainage Field
No. of exact length width of
ditches of each ditch C 5 feet ditches 3
depth of tc
feet ditches 32�
French Drain Required:
e�ei fear
inches
Authorized State Agent :� :\� ,fie-, f Date C
A.
Y
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