OP RHTE#Harnett County Department of Public Health 23445
PERMIT # 1 Operation Permit
C;K New Installatio c Tank ❑Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:;
Name: (owner) J J, j— jSUBDIVISION LOT # q
System Installer: G�--r'✓ck.,l''A'o Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms q
Type of Water Supply: ❑ Community [2"'Public ❑ Well Distance from well feet
System Type: '17C 5 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.
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 Authorization
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NtNPnI LUNUIlIUM:
I. 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 0 eration•
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V. Other:
❑
D -Box ❑
Following are the specifications
for the
Type of system: ❑
Conventional
Subsurface
No. of
Drainage Field
ditches
French Drain Reauired:
Authorized State
Pump ❑ Alarm ❑ 11201-ine ❑
sew disposal system on the above captioned property.
7Other Gy:
Iq-5- 7Z2/Z