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OPI. HTE#Qg-5-;Q" Harnett County Department of Public Health 21 3 6 2 PERMIT #Operation Permit New Installation iXZ Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: NC:3O Name: (owner) C v r-,e w-Lp,v4 4~p~,E S wC SUBDIVISION M~ c V> a c~-) LOT # G System Installer: fE-v ~~wN Registration # Basement with plumbing: ❑ Garage Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1b0 feet System Type: SiL _ 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. This svttom hat haen Inst2fled in rmmniianra with annlinhlo Nnrth rar h- fI Cron- P,d- se,,,, . T.....,.,,.- ..a n:. ..,._t _n _r .1. i___...____. r... pump ~0 ~ Vl„C2A7Y\t1LtcW Fro Q~cZ \ R 1.. 1 \ CL t _ `t xS ` t` I, E -~e 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~roperty. q Authorized State Agent Date Li l ~"hd Type of system: ❑ Conventional( Other lst1C",tus~util Septic Tank: tc9©Cf gallons Pump Tank: gallons Subsurface No. of exact length width of of depth ditches inches field ditches ( of each ditch ab3 feet ditches feet es french Drain Re wired: r feet a. ~r tol l ~ 9 ~Ni f 4 j u .o-4 r . i i eye 9