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OP RNTE#(%-5'IQ5a.7- Harnett County Department of Public Health 2 0 5 4 0 PERMIT # x354 Operation Permit New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion PROPERTY LOCATION: %L.Pr_k,R-p Name: (owner) C13 SUBDIVISION Ga,~wC~ L 0 T # E_ System Installer: Qzt~ 5~~~~Y.~-A•~~ Registration # Basement with plumbing: ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well cO0 feet System Type: ` 1L)O 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 I S'S-T EN^ RLm ~ Q i I 3 6o~xb0 ~.o wo pR~vE, n:Rrtn wnunturik 1. Performance: System shall perform in accordance with Rule .1961. 11. Monitoring. As required by Rule .1961. 111. Maintenance: As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ No)i~ If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other. Following are the specifications for the sewage disposal system on the above captioned prope~. Type of system: ❑ Conventional Other ZS1& R-C-0 t> 11O N Q FLQ Septic Tank: tad gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch 3 O© feet ditches 3 feet ditches 4 inches French Drain Reauired: \\nlinl4r fopt Authorized State Agent 2S Date 3 119 1 t-1 ~ . m.«y i } ~ xTY a..va ~y e , ' 4 a rv~ }}yyy~~ k , ~ W~] i lip k F Ak'Y~ 4 At- r },5 . t:* +y ktt e ` 1. A , k H r a' ` • y g (p t x r ti