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OPHTE# J s'o2e /moo Harnett County Department of Public Health PERMIT # a b-7 Operations Perm-it 2 2 3 5 3 d New Installation 2"' Septic Tank Etl""Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: J)--•`I' Name: (owner) c c 4-, u~ SUBDIVISION T~oF--E~.f% s e LOT # System Installer: Registration # Basement with plumbing: ❑ Garage C~7 - umber of Bedrooms Type of Water Supply: ❑ Community LJ_ P_ublic El Well Distance from well feet System Type: G 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. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization U a a i'V F Pr \ t ,Q ~e ~otd•<- rtKMII LUNUIIIUNJ: 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 11 If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other: ❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line Following are the specifications for the sew disposal system on he above captioned property. Type of system: ❑ Conventional Other a ?~FC9 w Septic Tank: 00 0 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch o2©c) feet ditches -3 feet ditches 1inches French Drain Required: Linear feet Authorized State Agen Date /z-J-- 2 ,8 14, 'S rFS C t ~ a a 5 : J ,n v F r : r e r ~ F [ r, 4 sp?'rr3f ':1 \s P J