OP RRHTE# C/S"-~~-6- Harnett County Department of Public Health
PERMIT #Operation Permit 21 9 0 0
New Installation _X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Ll
Type of Water Supply: ❑ Community TA Public ❑ Well Distance from well l O a 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.
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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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox.
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qv-? e--1 0 F-_ -V i.Q-,4 Septic Tank: 1 OOC~ gallons Pump Tank: \0o d gallons
Subsurface o. of exact length width of depth of
Drainage Field ditche 3 of each ditch 4_10 feet ditches 3 feet . ditches inches
French Drain Required: Linear,eet
Authorized State Agent Date