OP RHTE#-Os- HOW- Harnett County Department of Public Health 2 0 7 5 5
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repai- Nitrification Line ❑ Expansion
i PROPERTY LOcA ITO : \`I )
Name: (owner) u v C~ to SUBDIVISION P LOT # ~Z
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: Community - ` Public El Well Distance from well feet
System Type: -1 ( Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner ust contact Health Department 6 months prior to expiration for permit renewal.
ims system nas peen mstanea in compliance wilt
hcable North Carolina General Statutes, Rules for
Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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:
Following are the specifications for the sewage disposal syste on the above captioned property.
Type of system: ❑ Conventional er I'::' L.1 Septic Tank: ` J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch - feet ditches feet ditches :7 K inches
French Drain Required: Linear feet
Treatment and Disposal, and all conditions of the
Authorized State Agent` Date 1
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