OPHTE# Harnett County Department of Public Health 23981
PERMIT # 3��f-1� Operation Permit
( New Installation Septic Tank WA Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 215 `ONOFY205A a
Name: (owner) GNvcti S -, x—ci4 SUBDIVISION LOT # -0
System Installer: R9+y C.o4.S Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms '-1-
Type
Type of Water Supply: ❑ Community i3( Public ❑ Well Distance from well LQO feet
System Type: �'trTy Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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❑ D -Boz ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal synon the above cap Toned p*eperty.
Type of system: ❑ Conventional X Other f �> sc,:Z % Septic Tank: I COO gallons Pump Tank: gallons
Subsurface �No.of exact length width of depth of
Drainage Field dttUs a of each ditch feet ditches �_ feet ditches 30-A inches
French Drain Required, — Linear feet
Authorized State AgentDate 3
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