OP RRHTE# - QD jJW5RR Harnett County Department of Public Health 21 1 7 3
PERMIT # P? 553S Operation Permit
l New Installation -~4 Septic Tank ❑ Repair J4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: I S
Name: (owner) 4 SUBDIVISION X0120 T 100-k LOT # 1,~'~L
System Installer: Registration #
Basement with plumbing. ❑ Garage 1,~ Number of Bedrooms
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well ( 0 0 feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nm system nas oenn imtaleu in compoance witn
norm Laroima heneral )tatutes, Wes for )ewage Treatment and Disposal, and all conditions of the
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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.
III. 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 5%ther disposal ystem on the above captioned property.
Type of system: ❑ Conventional Vv,. T~ E- Z rI9V Septic Tank: 0 R gallons Pump Tank: f gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch (8a feet ditches feet ditches inches
french Drain Required: linear feet
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[Authorized State Agent - Date
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