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OPHTE# 13" S''���q Harnett County Department of Public Health 23139 PERMIT # ai `7 Operation Permit )] New Installation Z Septic Tank 'X Nitrification Line El Repair ❑ Expansion C PROPERTY LOCATION: N a Name: (owner) u\L-\<-\*' SUBDIVISION 4s2rTtq.-c- LOT # 41G System Installer: t—Aao. S,�Act,oc Registration # Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 9 Type of Water Supply: ❑ Community X Public ❑ Well Distance from well t oa 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. ,ms system nas peen instauea in compnance with apphcame north Larouna benerat xatutes, Rules tar Sewage treatment and rtnrlrl cunuiuuNS: I. Performance: II. Monitoring: III. Maintenance: IV. Operation: V. Other. B3 Z40' �ooNOr�,o N oN>^y D 2 v C NFn.t -CAGE why and all conditions of the Improvement Permit and Construction Authorization. System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ NOX If yes, see attached sheet for additional operation conditions, maintenance and reporting. ❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Other G z N:Low Septic Tank: I000 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches ( of each ditch 120 feet ditches 3 feet ditches �' "�© inches French Drain Reauired: Linear feet Authorized State Agent Date