OPHTE# Harnett County Department of Public Health 24295
PERMIT # QL Operation Permit
New Installation X Septic TankNitrification Line ElRepair El Expansion
PROPERTY LOC�
LOCATION: S%H t �o.a CQ>
Name: (owner) Cu mer , \'%c -L --s I N c SUBDIVISION CZk- Lj m. -, S6v so tv S LOT # Ste`' _
System Installer: RxLr)--,r N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t00 feet
System Type: ZtT a Types Y 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
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N;X
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal��s�l1''stero on the above ption roperty.
Type of system: ❑ Conventional Other 1..11AR�saE1L � Septic Tank: 1(0)00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 15:- fT feet ditches _ feet ditches B6 inches
French Drain Recurred: Zil�eet
Authorized State Agent 16"5 Date
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