OP RJITE# \A-5-35111AZ Harnett County Department of Public Health
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PERMIT # }_ Operation Permit
New Installation I Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:tiri�C.P.'C Z -N
Name: (owner) VJZ) SUBDIVISION LOT #
System Installer: &A—f-s Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms 3
Type of Water Supply: Elommun
Ci "Public ❑ Well Distance from well feet
System Type: - A 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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NtRNII LUNUIIIUNS:
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. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above caption property.
Type of system: ❑ Conventionall Other �1's f�r�`L �� Septic Tank: ! tS� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1Ub feet ditches feet ditches inches
French Drain ar feet
Authorized State Agent �� :' \(-6'ro Date l S