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OPHTE# IQ- C) Harnett County Department of Public Health 21331 PERMIT # Operation Permit New Installation 14 Septic Tank ❑ Repair ❑ Nitrification line ❑ Expansion PROPERTY LOCATION: H wj I\ Q Name: (owner) ?.e1_ Q-P~P.yp~ SUBDIVISION Wb CAr~r~~2G~AL LOT # System Installer: Registration # Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 190 4~ Type of Water Supply: ❑ Community ~1 Public ❑ Well Distance from well 100 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. I. 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~ IV. Operation: V. Other. If yes, see attached sheet for additional operation conditions, maintenance and reporting. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional ❑ Other Subsurface No. of exact length Drainage field ditches of each ditch feet French Drain Required: _ Linear Septic Tank: t00© gallons Pump Tank: gallons width of depth of ditches feet ditches inches Authorized State Agent Date 3115110