OP RRHTE# 1-7- 15 -,1 QQ_ Harnett County Department of Public Health 25056
PERMIT # Q9IW\ Operation Permit
New Installation )Q Septic Tank X Nitrification Lt F-1Repair11Expansion
f� PROPERTY LOCATION: LEMvEt— F>it�cx �
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Name: (owner) GP2% KogtNscku iAotr.E._) SUBDIVISION 11:G Jli LOT # 21
System Installer. Erol E Gii Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L�
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: _=. 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: System shall perform in accordance with Rule .1961.
ll. Monitoring As required by Rule .1961.
111. 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:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other Ar�S3 `SL �tat?L 3L 1 + 1 O� Septic Tank: S OO 10 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field of each ditch 8<:)0 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Tsai _1%i d13 Date
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