OP RRHTE# Harnett County Department of Public Health 2 0 41 5
PERMIT # Operation Permit
New Installation -E[ Septic Tank ❑ Repair 9 Nitrification Line ❑ Expansion
i PROPERTY LOCATION:'--/--k
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Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ~
Type of Water SgppI : ❑ Community ❑ Public `g Well Distance from well feet
System Type: ~v I=r~ .titi v n c 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.
LV
this system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authonzation.
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~~.VI\VIIIVI\J.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No N
If yes, see attached sheet for additional operation ci
maintenance and reporting.
Following are the specifications for the sewage dispopl system on the above captioned pr erty.
Type of system: ❑ Conventional .Ii~ Other .°~'\-f w.'; 7 (Septic Tank: gallons Pump Tank: i gallons
Subsurface No. of exact length width of depth of
Drainage Field ditchesof each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State
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