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OPHTE# t°1 Harnett County Department of Public Health PERMIT # �t)� Operation Permit 22800 )F New Installation 1� Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: ., c,,F_ N �,Q Name: (owner) �.� ��-�2` Mks SUBDIVISION tn� i��NS a NNZI LOT # 44 System Installer: 7�,n C..- Registration # Basement with plumbing: ❑ Garage Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well ! 02 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. PERMIT CONDITIONS: 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 ❑ NOA If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other: 7 T - q 104 ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line Following are the specifications for the sewage disposal system on the above captie ed property. Type of system: El Conventional � Other CN1'-%yZGO- cC���I Septic Tank: t®©Ci gallons Pump Tank: gallons Subsurface No. of _._ exact length width of depth of Drainage Field ditches each ditch A'A 0 feet ditches feet ditches t1 "30 inches French Drain Required: min ti v Authorized State Agent �' Date