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OPHTE# oY► X55 Harnett County Department of Public Health 210 8 3 PERMIT #3`Zs?J Operation Permit New Installation 'X~ Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: 1~1ae" Name: (owner) SUBDIVISION LOT # ?,0 System Installer: ~Go eDcL-c,• r-4 Registration # Basement with plumbing: ❑ Garage 'Z51, Number of Bedrooms Type of Water Supply: ❑ Community `lam Public ❑ Well Distance from well ~c,© feet System Type: '~ZL Types V and VI Systems expire in S 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 C1PQ`4.5 2D i S sY2ECC5Cl~E ~ uFFfrL ENV ~ I 3,`Xsa LAO* v ~-,a& L- ~.fJC.'G~RV4`.N C't rLnnu wnuntVnx 1. Performance: System shall perform in accordance with Rule .1961. 11. Monitoring: As required by Rule .1961. III. Maintenance: As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ No 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 property. Type of system: ❑ Conventional '5~ Other Q v~~~t 4 CHnc~he~ n _ Septic Tank: S 6 c5Q gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch GO feet ditches 3 feet ditches _l_ inches French Drain Required: s~ Liwar feet Authorized State Agent Date i , f E a _ 4 ~ at ~ yy a t f r f „ fir N~ <TS ~kr TM ~ ~ bg ~1 n r