OPHTE# Harnett County Department of Public Health 23956
PERMIT # ,ani& l Operation Permit
New Installation 2Septic Tank Ed�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ati.2ce
Name: (owner) SUBDIVISION o o: LOT # /3
System Installer. F6r Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -3
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: .11Z 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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rtnnu wnmuum:
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
one an cou0plons or 1@ improvemMt remit are 101RWcrion P00omanon.
RCPT i
A.4 Iaf'
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewagedisposal system on the above captioned property.
Type of system: ❑ Conventional Other '� Z Septic Tank: (000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches /45- XC) inches
French Drain Required: Linear feet
Authorized State Ag z e Date 11161.o2C)(G'