OP RRHTE# 0 -500- a`~ot $RR Harnett County Department of Public Health 2 0 5 8 4
PERMIT # aS;~a 5 Operation Permit
New Installation -f~- Septic Tank ❑ Repair -Nitrification Line ❑ Expansion
PROPERTY LOCATION: (l C a-~
Name: (owner) SUBDIVISION Oaf,(
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C'2o11 ~~A~( LOT # C _
System Installer: Registration #
Basement with plumbing: ❑ Garet Number of Bedrooms '3
Type of Water Supply: ❑ Community 9 Public ❑ Well Distance from well ` J feet
System Type: Qi' , c I c 4 "C)~-g Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
mo spcem nas oeen mstauea in compuance wan appucable North larohna General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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DCOMIT fA11nIT1A~1f.
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I. Performance
II. 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 ❑ Nk
If yes, see attached sheet for additional operation co ditions, maintenance and reporting
Following are the specifications for the sewage disposal sys em on the above captioned property.
Type of system: ❑ Conventional ~ Other M, c. h. L Septic Tank: 00 0 gallons Pump Tank: gallons
Subsurface No. of exact length 2 width of depth of
Drainage Field ditches of each ditch -3 L90 feet ditches 3 feet ditches ) x inrhac
French ram Required: Linear feet
Authorized State Agent U_ Date ~-3 - p
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