OPHTE#�"5� �a3 Harnett County Department of Public Health 24920
PERMIT #a`zi% Operation Permit
New Installation X, Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 31 14
Name: (owner)=Avt.t 22ca4410,i I ����Zvn6 ASUBDIVISION LOT #
System Installer. TGp p;,ao.w f Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community >( Public ❑ Well Distance from well feet
System Type:0. 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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I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NOV
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capdoNd property.
Type of system: ❑ Conventional Other QQ-N / Septic Tank 100 O gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field a of each ditch g O feet ditches 3 feet ditches 30'10 inches
French Drain Required: near feet
Authorized State Agent 3 Date Q-iail If
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