OPHTE# raj- > p o- 0,) ~D Harnett County Department of Public Health 2 0 7 2 2
PERMIT # 3 1 ~ ~ Operation Permit
New Installation c19--Se tic Tank ❑ Repair~Nitrification Line ❑ Expansion
PROPERTY LOCATION: L
Name: (owner) SUBDIVISION LOT # 1 L
System Installer: C C Registration #
Basement with plumbing: ❑ Garage F~( Number of Bedrooms
Type of Water S "ply: ❑ Communi 1 ~ Public ❑ Well Distance from well feet
System Type: 1` 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.
mu system nas peen mstaneo in compnance wren appncame norm taronna (jeneral statutes, Rules for kwage treatment and Disposal, and all conditions of the Improvement Permit and Constniction Authorization.
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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
If yes, see attached sheet for additional operation nditions, maintenance and reporting
Following are the specifications for the sewa a disposal stem on the above captioned property.
Type of system: ❑ Conventional Other M1 C , (,t ~A 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 C 1, ~ io, Date ~'(~l T
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