OPHTE# Harnett County Department of Public Health 2407
PERMIT # a$�O6 Operation Permit
New Installation ;K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 41�):)5
Name: (owner) Qoa,Ecr' o MSD F—LttN SUBDIVISION Q--9 LOT #
System Installer. C NcL0 "v%5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ElWell Distance from well feet
System Type: a Types V and VI Systems expire in 5 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 conditiontof the Improvement Permit and Construction Authorization
rbxnu CUNun1uN6:
I. Performance: System shall perform in accordance with Rule
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional oper,
IV. Operation:
V. Other.
1961.
uo s�nC—
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 X Other "E--7
Z. 'Ft. es W Septic
Tank: I t50 d gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field d'
of each ditch 1 S' feet
ditches feet
^ 7�
ditches �_ inches
French Drain Required: Linear feet
Authorized State Agent ¢.(ary Date
I(.- 5-`3vz)�Q
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