OPHTE# I o-sQ--4s-714 Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 6 3
New Installation -X, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Pdwe~ L
Name: (owner) ALL. A lM v~o r~P,S L r ~Q- SUBDIVISION LOT #
System Installer: Y`R'kL Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community IX Public ❑ Well Distance from well 14 ° feet
System Type: 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.
uns system nas oeen mstaneo in compoance wrtn appncame norm t.arouna uenerai Ntatutes, Wes for sewage treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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rtnMtl Lunulnuns:
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 'V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
❑ D-Box ❑ Pump ❑
Following are the sp cifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditchef-- 31 of each ditch IL 0 feet
French Drain Required: Linea-re
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: I O 0 4 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Agent Date -71--Z\16
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