OP RNTE# DY-5-3a l 93o2 R Harnett County Department of Public Health 2 0 7 7 0
PERMIT # 2 5-573 Operation Permit
New Installation pll~ Septic Tank ❑ RepT~ Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) cn n~ -•.~-.r~ 1 SUBDIVISION S't LOT #
System Installer. Registration #
Basement with plumbing. ❑ Garage, Number of Bedrooms
Type of Water Suppllt~ ❑ munity ❑ Public El Distance from well feet
System Type: _ Com W `I Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact~lealth Department 6 months prior to expiration for permit renewal.
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This system has been installed in compliance with applicable North Carolina General Sratutes~, Rules wage 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:
System shall perform in accordance with Rule .1961. 1 4-
As required by Rule .1961.
As required by Rule .1961. Other.
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IV. Operation:
V. 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 sys em on the above captioned property.
Type of system: ❑ Conventional ther Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ~id _ feet ditches feet ditches v~ inches
French Drain Required: Linear feet(
Authorized State Agent W l Date C~
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