OP RHTE# ~7z Harnett County Department of Public Health 21 2 7 6
PERMIT # a 5~y Operation Permit
P~New Installation 1~ Se tic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: ctls 4 9.14,
Name: (owner)1r~~~~~ ft~~g~l SUBDIVISION LOT #
System Installer: kw'.,r, mow: rc ` Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -
Type of Water Supply: ❑ Community V 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.
ums sruem nas peen mscaiea in compoance wim appucame Win laronna beneral )tatutes, Rules for
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Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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L Performance: System shall perform in accordance with Rule .1961.
11. 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 sews
disposal system on the above captioned property.
Type of system:
❑ Conventional O
ther 6 Z F& W
Septic Tank:
Subsurface
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No. of
-3
exact length
width of
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ditches
of each ditch feet
ditches
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gallons Pump Tank: gallons
depth of
feet ditches 'Ac inches
french Drain Required: Linear feet
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Authorized State Age Date
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