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OPHTE# C)'l ~©4 Harnett County Department of Public Health 2 0 5 5 8 PERMIT # Operation Permit New Installation ',fQ Septic Tank ❑ RepairrX Nitrification Line ❑ Expansion C.ala.~n , PROPERTY LOCATION: Name: (owner) 5S,50 e-WISti t 76m M~ P s~AN C.wviicH SUBDIVISION LOT # System Installer. T~~ Nl nvt r,5 Registration # Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well t COO feet System Type: = u 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. Inns 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. t5~ 31~~ 4 Q ~O S 9- iZli W PERMIT rmmn1TlAN(- I. 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 ❑ N If yes, see attached sheet for additional operation cc IV. Operation: V. Other maintenance and reporting. Following are the specifications for the Fge disposal system on the above captioned property. Type of system: El Conventional Other to E CA \ PS Septic Tank: ► 0 0 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage field ditches of each ditch 400 feet ditches -'s feet ditches inches French Drain Reouired:_ ~inpa t Authorized State Agent y A15 Date Li ~3O [ 0 Ul Q~ n y i A O Q f S 4 rt y T p i ii ('j w fi i rr ILI 9 Y C! ~ r i t kb w %.i fP 3f r~ ~ sY M V ~ 'A Or a i 71 10 M S ~ ~ 1 S r`f N• h-: c y ~ ~.J Ct ST 'Y (P ri ;f w ry m c •1 • Q~IC W ~ ,x Dt {~J 1. Sf: ^ m ~ ° LP S: to It, CD r, hµ rO 4 ,lL~V W Ai tp Y t ~ r -An y i