OP RHTE# s lK--yJ 56sPz Harnett County Department of Public Health 2 0 6 4 5
PERMIT # Operation Permit
New Installation [Septic Tank ❑ Repair W Nitrification Line ❑ Expansion
PROPERTY LOCATION: I i_ 1
Name: (owner) ~ ✓ SUBDIVISION Jljh .-t/ LOT #
System Installer; Registration #
Basement with plumbing: ❑ Garage ~B- Number of Bedrooms 3
Type of Water Sup# ❑ Community )~4--Public ❑ Well Distance from well feet
System Type: Y' J" ~Gt Lj 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.
This system has been installed in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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
IV. Operation:
V. Other.
Permit and Construction Authorization.
maintenance and reporting.
Following are the specifications for the sewa a disposals em on the above c tinned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches- feet ditches _ inches
French Drain Required: 1-inear feet
Authorized State Agent Date 0 S-
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