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OPHTE# Q1'5-1~311~ Harnett County Department of Public Health 2 0 7 8 4 PERMIT # 4,A 0 eration Permit New Installation Septic Tank ❑ Repair)' Nitrification Line ❑ Expansion PROPERTY LOCATION: Name: (owner) _lax,, fl ~v~ lot c~+\tC c, SUBDIVISION LOT # a) System Installer: o~ES Registration # Basement with plumbing: ❑ GarageA Number of Bedrooms Type of Water Supply: ❑ Community X Public ❑ Well Distance from well tbtb feet + System Type: 1~x 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. mm ~yuem nas peen mstanea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. 3 0 © Q.p"N A6E. EPV5 EE79"~ 5) G t PERMIT rnuhITirluC• 12+vpt,cr~o~1 / I J I~ I. Performance: II. Monitoring: III. Maintenance: IV. Operation: V. Other. System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ N9)1~ If yes, see attached sheet for additional operation conditions, maintenance and reporting. Following are the s eci6cations for the sewage disposal system on the above captioned property. Type of system: Conventional ❑ Other Subsurface No. of exact length Drainage Field ditches-=- of each ditch LAC) feet French Drain Reouired: Septic Tank: 1040 gallons Pump Tank: gallons width of depth of ditches 3 feet ditches I8 _ inches Authorized State Agent Date ?3 t~ ~,I