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OPHTE# o-1-5- K751 Harnett County Department of Public Health 19921 PERMIT # Operation Permit New Installation ~ Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion PROPERTY LOCATION: Name: (owner) l4 u 614 5 u Q-1C-.-, SUBDIVISION LOT # a System Installer. yT,3 Sraz•~~-L Registration # Basement with plumbing: ❑ Garage X Number of Bedrooms 3 Type of Water Supply: ❑ Community 14 Public ❑ Well Distance from well ynn feet System Type: ZL 3o Types Y and YI Systems expire in S years. (In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal. >Pa 'w Mn wnim ea in wrm apput earn L"na Wwttat NMta, Aida fa kwW Treamtent and OitposA and Al (Wdo to of the Permit and (oatrX00n Authoriubm rJ8 3 eoe.,~. NovcE. ~s~ a3E~ y A 1 V E _ PFewtz rnunrttnr+c. 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 ❑ 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 Size of tank: Septic Tank: j c)00 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage field ditches 3 of each ditch t©U feet ditches 3 feet ditches C~ inches French Drain Reouired: t®r fePr~ Authorized State Agent ~ ~ ~ V-5 Date 1)151(N