OPHTE#a -55371 t I Harnett County Department of Public Health 23861
PERMIT # Qr454Operation Permit
New Installation )� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO[ATION: nor
Name: (owner) K XN (7cxaS'c'1NC:\0r6 SUBDIVISION 0Plt cN"E LOT # _
System Installer. Q—S %d Z tAs> Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L
Type of Water Supply: ❑ Commune Public El Well Distance from well 1b�_ feet
System Type: � 2� 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 Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Lonsoucnon xumonzaaun.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As requited by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operano a
maintenance and reporting.
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2O1-ine
❑ PWR Line
Following are the
specifications for
the sewage disposals stem on the above captioned property.
Type of system:
El Conventional
K Other E- Z 'C7a.c
Septic Tank: e d gallons
Pump Tank gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch •'f O feet
ditches J3_ feet
ditches_ inches
French Drain Requim
Linear feet
Authorized State Agent Date
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