OP RRHTE#1 &S— SM -3010, Harnett County Department of Public Health 24307
PERMIT # a �1 Ea °1 Operation Permit
'K New Installation �& Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: `JimN ,w Foo-. 0Q-
Name:
QName: (owner) Ei'i Q)aasi-m Vjoc•+ES SUBDIVISION '4At-wv1 GaovE LOT # _j'
System Installer: dst 10Registration #
Basement with plumbing: ❑ Garage 'r�< Number of Bedrooms
Type of Water Supply: ❑ Community "IK Public ❑ Well Distance from well t EPQ� feet
System Type: QXZ):2 Types Y and YI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
mos system no 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 Authorisation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
It. 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:
Y. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
n -
Other PVc Ty E2 Fi a,, Septic Tank: 50007
gallons Pump Tank: 1000 gallons
SubsurfaceNo.
of
exact length width of
3 3
depth of
"l—1
Drainage Field
ditches
of each ditch y feet ditches
feet ditches inches
French Drain Required:
r feet
Authorized State Agent L\\ \ ycT Date _11
1 70:447�
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