OPHTE# -3r_0Q- q Harnett County Department of Public Health 2 0 6 4 2
PERMIT #Z Operation Permit
New InstallationO<_ Septic Tank ❑ Repair V Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) LSD A t u SUBDIVISION a~llt LOT
System Installer. ~ 0 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water SupplCommunity Public ❑ Well Distance from well feet
System Type: i ►z u 1~y C'/ 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.
ims system nas peen mstaneo in
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Treatment and Disposal, and all conditions of the Improves
Permit and construction Authorization.
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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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
following are the specifications for the sewage disposal sypegi on the above captioned property.
Type of system: ❑ Conventional Other s-4 *.-A, L,2 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 inches
French Drain Required: linear feet
Authorized State Agent Date
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