OPRE# Harnett County Department of Public Health 19897
PERMIT # 1 Operation Permit
~"ew Installation C~-Septic Tank ❑ Repair E3~ Nitrification Line ❑ Expansion
PROPERTY LOCATION. J y
Name: (owner) h k SUBDIVISION t t LOT
System Installer. Registration # 3 3 31
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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.
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Mtn ypratk nortti t.ambna Genaal sum
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Auks for Smgpe TrumRm ad asposal, and al cordws of dk Improrensmt Pamir and Cmunxbw kidmraioe
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Promrr rAunn"nuc.
1. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
Y. 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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
following are the s cations for the sewage disposal system on a above captioned property.
Type of system: Conventional ❑ Other Size of tank: Septic Tank: J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of >
Drainage Field ditches of each ditch feet ditches feet ditches , b inehm
French Drain Required: Linear feet
Authorized State Agent Date U r~'