OPHTE# 1-7"5'tiZJ) I Harnett County Department of Public Health 24900
PERMIT # Zq1 Q'Snt Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
V Fa\oreoc �vE
Name: (owner) QFs.ca, kot� p
s 1 UC. SUBDIVISION ` s i'TMesw tN e LOT #
System Installer: `Q�l't) s3 S—\ v6\ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1:M G 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 Tream ent and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
111. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional �, Other EZ. Fia%„ Septic Tank: 100(3 gallons Pump Tank: gallons
Subsurface —Novo exact length width of depth of
Drainage Field ditches of each ditch �a-►0 feet ditches 3 feet ditches K-30 inches
French Drain Require ear feet
Authorized State Aeent QA )'.5 Date
11-5- 9-J39