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OPHTE#~~~s Harnett County Department of Public Health 21090 PERMIT # a!55,60 Operation Permit j New Installation Septic Tank ❑ Repair X Nitrification Line ❑ Expansion PROPERTY LOCATION: Pce~~t~o~~z Qzy Name: (owner) Don-, 'QEq `~kw ,a 1 SUBDIVISION LOT # System Installer: C, E.n,,L-o E,r,e Registration # Basement with plumbing: ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community 79 Public ❑ Well Distance from well V©~ feet System Type: Via, 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. uns srxem nos Deco mstanea m compnance unto app~uabie norm t,arohna General Statutes, Rules or Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. y5 cf4i'nt.~~ 1 0 40 C N - I rnumm~ur uw~i wnvn wn~. 1. 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 ❑ NoX If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other. Sz.a \'J v.~ azvf05."L_ w2 ~o~sQ ~~6+1 ~~.,Eocu ~mw following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional ~j Other EZ r~i o N Septic Tank: ► o o c> gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage field ditches 3 of each ditch feet ditches 3 feet ditches I g °a~ inches French Drain Required: feet Authorized State Agent g-~x5 Date ►0 il~F J41 'R~ F :S md► to ~ firm's. '4. . •.l .1' ~~t,~, t :r ~ ~ a .iF' a n s k 41, a x - - - s. . T~ - 1 s~ a. ~I l x