OP RHTE# 06'1 Harnett County Department of Public Health 213 81
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line El Expansion
PROPERTY LOCA L ld
Name: (owner) SUBDIVISION Af LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water S ply: El Community Public ❑ Well Distance from well dD feet
System Type: ~ "'L ~~C>v r 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.
[his 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 Authorization.
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PFRNIT r(MI)ITIltldt-
I. 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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch _ feet ditches feet ditches V, inrhoc
rent rain Required: Linear feet
Authorized State Agent - ~i Date
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