OP RHTE# cX-9 " o92 s-19 ~ Harnett County Department of Public Health 21 3 71
PERMIT # X S Operation Permit
New Installations Septic Tank ❑ Rep Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner)~t / SUBDIVISION LOT #
System Installer: r'~wn Registration #
Basement with plumbing. ❑ Garage l Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well /00 feet
System Type: , c VI LLF- 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.
ims system nas peen mstaneo in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
and all conditions of the
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PERMIT CONDITIONS:
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Permit and Construction Authorization.
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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qw~ck (-l rIKU-V)f Septic Tank: J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of p
Drainage Field ditches of each ditch feet ditches _3 feet ditches `A i inches
French Drain Required: Linear feet
Authorized State Agent Date 1
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