OPHTE# Harnett County Department of Public Health 2 0 9 8 5
PERMIT # Operation Permit
New Installation b2!-Septic Tank ❑ Repair &r Nitrification Line ❑ Expansion
PROPERTY LOCATION: 7 « /24
Name: (owner) ~ - Ad y ei, r 5 SUBDIVISION C,-
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System Installer. ~ t ~ LOT #
h Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi~` [Public ❑ Well Distance from well Its feet
System Type: ~K e h . ITT<-/ 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.
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I. Performance
II. Monitoring:
Ill. Maintenance:
System shall perform in accordance with Rule .1961. k j c r
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No TX
If yes, see attached sheet for additional operation ditions, maintenance and reporting
Following are the specifications for the sewage disposal Icyeem on the above captioned property.
Type of system: ❑ Conventional 4~ Other k(' c~' Septic Tank: o 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of l
Drainage field ditches _ of each ditch -13-o feet ditchm foot ac,,tia ~
-13-o
French Drain Required: linear feet
Authorized State Agent Date o~~ "
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