OPHTE# It -6 - 3klaa Harnett County Department of Public Health 24667
PERMIT # L2gf S Operation Permit
D---kew Installation 1�1- 'Septic Tank tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Qutecryicr6C loo yc-b «, SUBDIVISION rt1 e 1`. ,F: LOT #
System Installer. � - Registration #
Basement with plumbing: ❑ Garage Numb r of Bedrooms _ y_
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well feet
System Type: Z t%� 1, A, .r{- un Ser TD— 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:
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 92'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLIne ❑ PWR Line
Following are the specifications for the sewagefi5poaaf system on the above captioned erty.
Type of system: ❑ Conventional P Other C '.L _.l..r'.� 1,� _ Septic Tank _ gallons Pump Tank gallons
Subsurface No. of Artr- 310exact length width of depth of
Drainage Field ditches .3 of each ditch 95 130 feet ditches _ feet ditches Z� inrAes
French Dain Required: Linear feet
Authorized State Agent Date 0EI l& /7 -o -,T-
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