OP RRHTE# o"7-5DQ-)T~?01 Harnett County Department of Public Health 2 0 5 7 6
PERMIT # Operation Permit
New Installation-Septic Tank ❑ Repa r Nitrification Line ❑ Expansion
PROPERTY LOCATIO e r
Name: (owner) Q~ C SUBDIVISION If 2- s 70-
r..g F . LOT #
System Installer. 2 0 Uj v - Registration #
Basement with plumbing: ❑ Garage mber of Bedrooms
Type of Water Supply: ❑ Co munity Public ❑ Well Distance fro well )CP3 - feet
System Type: ~ -C Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner 1mu1s contact Health Department 6 months prior to expiration for permit renewal.
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Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
11. 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 77
If yes, see attached sheet for additional operat n m
maintenance and reporting.
following are the specifications for the sewage disposal system on t~above captioned property.
Type of system: ❑ Conventional l~ther Q VV C~ Q" Septic Tank: aDi-D- gallons Pump Tank: gallons
Subsurface No. of } exact length width of depth of
Drainage field ditches F of each ditch- feet ditches feet ditches Z inches
french Drain Required: linear feet
Authorized State Agent r Date -
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Aug,
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44 i3 -
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