OP RRHTE# Harnett County Department of Public Health 2 0 5 7 9
PERMIT # a Y) Operation Permit
New Installation Septic Tank ❑ Repair;' .Nitrification Line ❑ Expansion
PROPERTY LOCATION:..
11
Name: (owner) SUBDIVISION 47D' Res7" 0(4 LOT # )QL
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Suppl : ❑ Community ' Public -*-11W Distance from well feet
System Type: N t I , y 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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PFRMIT rnunlTlnNC•
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
V. Other
Subsurface system operator required? Yes ❑ No fA
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal sy tem on the above captioned property.
Type of system: ❑ Conventional E Other U-^ , t V Septic Tank: E-__=- gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch A ~ ° feet ditches -3 feet ditches ` X , 4j
`Vt inchat
French rain equire : Linear feet
Authorized State Agent Date 3-1
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