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OPHTE# 0 -S-- Harnett County Department of Public Health 21127 PERMIT # IZY-,Z 7'1 Neratlon Permit ~d- New Installation C~Ieptic Tank ❑ Repair P--Nitrification Line ❑ Expansion PROPERTY LOCATION: 02"7~s Name: (owner)Cu.L-. I ~Ae„t r SUBDIVISION r~ f ilk ey LOT # System Installer: i d a w A Registration # Basement with plumbing: ❑ Garage umber of Bedrooms .3 Type of Water Supply: ❑ Community 12--Public ❑ Well Distance from well feet System Type: B 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. d ,r Div- rInrin WnuUtVnz 1. 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. M V. Other T,trJ~C! d- , 'C f OTC ,,,k V:-~ ~tf Following are the specifications for the sewage dispo al system ton the above captioned pr perty. Type of system: ❑ Conventional 4' Other P"r-'P Tc ©-`tt~t crSeptic Tank: coo gallons Pump Tank: a gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch feet ditches feet ditches C inches French Drain Reauired: Lifeat Authorized State Agent '~`s Date It s~d~ v cf_ " lilt' a~ 7 A4 Jt- ~ x r r 74- sw r~ Y d ~ d ~ err rV f, 441, v n~ulv0 b lb f"A~ 1 ~ 1 7 RR a a 3 4 r1j. -1 t d at 4' ~ p ` i 11 lit . maw F~ Ilk e . t ~r a r` ~ ~ S t t i a F i 1 R o }AL 40