OP RRH T E # Rg Harnett County Department of Public Health 2 0 7 6 8
PERMIT # ~ Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:..
Name: (owner) ~c SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 1~Number of Bedrooms
Type of Water Suppl • ❑ Communi 164--Pu ❑ Well Distance from well /03 feet
System Type: , c Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nm system nos ueen mscaleo in
wim appucatne norm larouna henerai Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
1. 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 ❑ No Z
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the se a disposal sy em on the above captioned property.
Type of system: ❑ Conventional waOther Septic Tank: C' J 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: Linear feet
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Authorized State Agent I \ k c V-J Date J/ - 1'~
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