OP RHTE# I.7- S-411649., Harnett County Department of Public Health 24619
PERMIT # QL 1 Sob Operation Permit
New Installation V Septic Tank Nitrification \`Line El Repair ❑ Expansion
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PROPERTY LOCATION: CAa. �ao,� ,a.1. �Qp
Name: (owner) �y Q091,-1 na r' VrEJ SUBDIVISION a011-lL LOT # 6
System Installer: E0o'F- Gva vE1L Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms�L
Type of Water Supply: ❑ Community �K Public ❑ Well Distance from well feet
System Type: 91;r=a Types V and VI Systems expire in S years.
(In accordance with Table V a) J 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 Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Com osmon Authorization
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PERMIT CONDITIONS
I. 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:
Other.
❑
D -Boz
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
following are the
specifications for
the sewage disposal system on the abyyve captioned pr,)o�crty.
Type of system:
El Conventional
Other C"k-1� 1IlIkk N 10) Septic Tank: 10040
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage-Fw
ditches
1 of each ditch 1 !�—O feet ditches 3
feet ditches R '34 inches
French Drain Required:
Linear feet
Authorized State Agent ` li Date
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