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OPHTE# 1 C) 5s '-�t-Arq Harnett County Department of Public Health PERMIT #��_ Operation Permit 22910 New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: r1C� e Name: (owner) U +L. Qt,t2-22 SUBDIVISION P�, , o v,,0 V; 7i T LOT # 15_ System Installer: P.C.) tF Registration # Basement with plumbing: ❑ Garage "§� Number of Bedrooms Type of Water Supply: El Community Public El Well Distance from well 10 6 feet System Type: o. 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. PERMIT CONDITIONS: I. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule .1961. 111. 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: ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line Following are the specifications for the sewage disposal system on the above captioned property. Type of system: El Conventional Other ��- �L- ®tir Septic Tank: 6 ©� O gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Fie ditches of each ditch ® feet ditches feet ditches 1$ 34 inches French Drain Required near feet Authorized State Agent \ yy\\ v� Date ') t°T