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OPHTE#o~-5-a,3oa~ Harnett County Department of Public Health 21325 PERMIT #Operation Permit 1 New Installation Septic Tank El Repai Nitrification Line ❑ Expansion PROPERTY LOCATION: ~owoE2os~. Name: (owner) C~ ~ t mss, \~o n.Es SUBDIVISION C -14W L N 14 SEaS.atj,-, -LOT # -c),3 System Installer: IE© r1 Registration # Basement with plumbing: ❑ Garage( Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet System Type: =9 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. Ihis 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 l P2E-A i 150 wo va E ca' 40r 4ZO ISM ( Power .b O~ ` t Ea o 2 se c~~N r ~L4 nrnurr rnummAur. 1. Performance: 11. Monitoring: III. Maintenance: System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other. IV. Operation: V. Other. Subsurface system operator required? Yes ❑ Nox If yes, see attached sheet for additional operation conditions, maintenance and reporting Following are the specifications for the sewage disposal system on the above captione roperty. Type of system: ❑ Conventional Other CwtarlgE2 ~Qur~~c Septic Tank: td6o' gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch 1 tea. feet ditches 3 feet ditches a inches French Drain Required: 'near ket Authorized State Agent \ ~Q~~ Date 3/1011 - ~ ~ > ~ ; ' i ~ ~ i i ( ~ ~ ? i 1 ' ~ ~ t t } ~ ii ' k f