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OP RHTE# 1 3 °5- 30,5 )S Q_ Harnett County Department of Public Health PERMIT # �-�y3D Operation Permit �, 22916 n;.) New Installatio Septic Tank X Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: 00c-s Name: (owner) '10 s,a _ SUBDIVISION 126-55CP s F- yC_G- LOT # System Installer: 1r oq-,-a 0--5 9L U snE3» Q, Registration # Basement with plumbing: ❑ Garage Number of Bedrooms Ll Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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. 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 ❑ NOX 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:,. ❑ Conventional Other g d mnP l ° ti-a Septic Tank: � b©® gallons Pump Tank: gallons Subsurface _90.—Of , exact length width of depth of Drainage Field ditches of each ditch , a �) feet ditches feet ditches ` inches t.. French Drain Reauired: e- Linea Authorized State APent R�5 Date 'A I Z-3 13 -s C 5IS,