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OPHTE# o4~ Harnett County Department of Public Health 21227 PERMIT # c~53y~ Operation Permit New Installation X Septic Tank ❑ RepairrX Nitrification Line ❑ Expansion PROPERTY LOCATION: So,,,to~ 1 a 6e,4 Name: (owner) J~cr~-:6 trot-j SUBDIVISION \,,,Ge- Q.a s- LOT # System Installer: -mac o gu.a w Registration # Basement with plumbing. ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well VO C7 feet System Type: .1L1Types 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 ~O f PUMP '4G ~VN~/Enr.QNp~ti D R 1 C stvoY T1N6 N C~ rCn1911 LIJINUIl URY 1. Performance: System shall perform in accordance with Rule .1961. Il. 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 Other Q„r ,eCsAtaM9r=2.- Septic Tank: fO ©Cf gallons Pump Tank: loc~ gallons Subsurface No. of exact length width of depth of Drainage Field ditches- of each ditch t 3 O feet ditches 3 feet ditches inches French Drain Required: linear feet Authorized State Agent Date 1 I-)