OP RHTE# Harnett County Department of Public Health 19899
PERMIT # Operation Permit
rationia?ptitfialfk ❑ Repairij Nitrification line - xpansion
PROPERTY LOICATION- - ~l J
Name: (owner) SUBDIVISION C LOT #
System Installer. Registration # a 6
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply. ❑ Community P~ Public ❑ Well Distance from well feet
System Type: 1z { CST Types V and VI Systems expire in 5 years.
(in accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
0 ~ S o w'L0 i1n
This system has been insWW in canoance with appkible Nash Carolina &wA Star44 NO Dor Sewage Tmm"t and Disposal, and A conditions of the hKovemdrt Permit and Cosntnsction kd*6 afim
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Kok .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
following are the specifications for the sewage disposals tem on the above captioned property. I , l
Type of system: ❑ Conventional Other L4_ Size of tank: Septic Tank: e . ~ ~ gallons Pump Tank: 0 ~ r L gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches Z~ inches
french Drain Required: Linear feet
Authorized State Agent L' 1. ) Date