OPH T E # S(�' S� Harnett County Department of Public Health
PERMIT # ��� Operation Permit 24303
New Installation 'tR, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION: Icy
Name: (owner) Q�cVtKLO A�tis dW6.GOR . SUBDIVISION P�s��NS to A LOT # a�
System Installer. .F ::)r r 4 r j x s r r�qz L -T I Registration #
Basement with plumbing: ❑ GaragVX Number of Bedrooms Lf- k
Type of Water Supply: ❑ Com uni "K Public ❑ Well Distance from well t nO feet
System Type: _ a a 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 hu been imaged in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal. and all conditions of the Improvement Permit and Constmrtion Authorisation.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Max
If yes, see attached sheet for additional operation co
IV. Operation:
V. Other.
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 Other QVI�9—'So C'LFL4,, Septic Tank: IOC gallons Pump Tank: '000 gallons
Subsurface No. of exact length width of depth of
Drainage Fieldditches rl of each ditch Sad feet ditches 3 feet ditches _ inches
French Drain Required: � Linear feet
Authorized State Agent ' -,!*, \\ f~G 5 Date
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