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OPHTE#. Harnett County Department of Public Health 21328 PERMIT # a.S~B9 Operation Permit New Installation Septic Tank ❑ Repairr Nitrification Line ❑ Expansion PROPERTY LOCATION: M aq Name: (owner) SUBDIVISION p~,A ~o LOT # lC%Z:) System Installer: tFs~ $4?-011 . Registration # Basement with plumbing: ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well V©O feet System Type: 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. n' >rxem 1w ueen mscauea in with applicable North tarolma General Statutes, Rules for Sewage Treatment and `7() and all conditions of the Improvement Permit and Construction Authorization. ~ as°Ia~ aEO. t ~C tsu ~ Alf 3 a , r 0 1, - 7 ' Q aea. 5 gx 1\ ' / 2 gs1~6 FO Zo PERMIT rmmnfTllluc- 160" I. Performance: System shall perform in accordance with Rule .1961. 11. 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: Following are the specifications for the sewage disposal system on the above captio d property. Type of system: ❑ Conventional1 Other CNs~m~ Gn /Q ~cw 4 Septic Tank: 6D gallons Pump Tank gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch I D feet ditches- feet ditches J8' -30 inches French Drain Required: lln.r Authorized State Agent. (L.S Date 31 vy xt i t"~'ir 37fr r , Y IN',V 401 . H y 5 4 t. m ~ oil tit 5 F F~ Ksa 1 .2