OPNTE# %U` K— 3 D Harnett County Department of Public Health 24200
PERMIT # Z1 2;9 Operation Permit
�ew Installation R' Septic Tank litriffcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) u A K ida C'�Re�, �c.L/P� SUBDIVISION LOT #
System Installer: `6Axf_Ao _ - Registration #
Basement with plumbing: ❑ Garage lum r of Bedrooms
Type of Water Supply: ❑ Cammuni ublic 11 Well Distance from well PA- feet
System Type: ,y Z 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 North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
1. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. / Other.
L7 D -Boz ❑ Pump ❑ Alarm ❑ H2OLims ❑ PWR Line
Following are the specifications for the sewage -disposal system on gie above pct ed pro
Type of system: Conventional f' Other a1 JY# C Septic Tank i U(d gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch IJ feet ditches 3 feet ditches inches
hrench Uram Required: Linear feet
Authorized State Agent �'' // " Date