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OP RHTE# Va "�a`����?�. Harnett County Department of Public Health 22762 PERMIT # �� 1 Operation Permit New Installation �4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: 'D oGS t� Name: (owner) Cc ct \jv C) a SUBDIVISION her b-T i Gem R >oGE LOT # System Installer: 1 z- ioQ.3ot-% t..vrn5tNa Registration # Basement with plumbing: ❑ Garage X Number of Bedrooms 3 Type of Water Supply: ❑ Community -.E� Public ❑ Well Distance from well 1010 feet System Type: � 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 PERMIT CONDITIONS: I. Performance: II. Monitoring: III. Maintenance: IV. Operation: 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. V. Other: ❑ D -Box ❑ Pump ❑ Following are the specifications for the sewage disposal system on the above ca tioned property. Type of system: El Conventional Other Pv w* 1 a Z- wr! Subsurface No.� exact length Drainage Field ditches of each ditch i O feet French Drain Required: feet Authorized State C Alarm ❑ Septic Tank: ® ©© width of ditches 3 Date H2O1-ine ❑ PWR Line gallons Pump Tank: 1O ®� gallons depth of feet ditches inches