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OPHTE#01Harnett County Department of Public Health 19939 PERMIT # 3A09Operation Permit New Installation Septic Tank ❑ Repairq Nitrification Line ❑ Expansion PROPERTY LOICATION: 6ya.0 M Name: (owner) It ss~ ~ost 54 N SUBDIVISION W E i-n LOT System Installer. tr<<s S~2~c~ A ,o Registration # Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -3 Type of Water Supply. ❑ Community '5KI, 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. ims s tem nu OW installed in cam once with appficabfe !forth Carafina Gene+af Sntutes. Rules for Sewage Treatment and 6isposat. and all conditiom of the Im orement Permit and Construction Authonza ors ~Of x3p ~S 60' A cam, PERMIT CONDITIONS: 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~ If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: Other. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: `R Conventional ❑ Other Size of tank: Septic Tank: I ob O gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches- of each ditch S © feet ditches 3 feet ditches a , a.. inches French Drain Renuirrd• t r_ Authorized State Agent : ~ . Q-5 Date