OP RHTE#r5- S-3Q-40a9—Harnett County Department of Public Health 24609
PERMIT # Q:t'+ K Operation Permit
New Installation "tk Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: LEE Co v-" L),,aa ?,r, s�
Name: (owner) C�)oN 0-y Lo 4 C- SUBDIVISION LOT # of
System Installer: v r_i rxN % 1JLL tadw Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ` Public ❑ Well Distance from well feet
System Type: 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.
MIS 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 Amhoria6on.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capti ed property.
Type of system: El Conventional 'K Other C"yr&so— �Q Septic Tank: si43 U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch 1400 feet ditches 3 feet ditches inches
French Drain Required• � Linear feet
Authorized State Agent V�C-H3 Date --71 31
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