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OP RHTE# SOHarnett County Department of Public Health 21 4 91 PERMIT #Operation Permit New Installation Septic Tank ❑ Repair Nitrification Line El Expansion PROPERTY LOCATION: ~M U P-1- ~ ~ Name: (owner) 1 } 1-~ N~ cxzs N G SUBDIVISION Fex~-~~ ©f.,.<,s LOT # 13~ System Installer: OT N.5 ~cz.•c.Ya .r•r tom' Registration # Basement with plumbing. ❑ Garage 'K Number of Bedrooms 3 Type of Water Supply: ❑ Community 4-'q, Public ❑ Well Distance from well 100 feet System Type: a 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 srscem nay Deen mnanea in i wan appocable north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. \L nrnulr rnunlrlnur % -kz 1 ~n1111 lVl\VIIIVI\J. 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 ❑ N0A 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 property. Type of system: ❑ Conventional X Other E Z ~'L o w Septic Tank: -10(!) 0 gallons Pump Tank gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch $ feet ditches feet ditches a inches French Drain Required: Linear feet Authorized State Agent ~ QC-,y Date 4w r. I 1 L I I w AKit n e r a~~ F `t jF Et Yp ~ ~ ~ ~ k }lll _n p~ 3 1r ~3t~. Ar, 1 f `TWO!, J - r2 r a> •m k,L t %t 4 ~ f All 1`\. - 3, ~ 'tea 1 x ~r w ~t 'A I ~ a r s ~ ~ `ate a'r p r ~ £ _ ~ y ~ ..sp' ~ t x tr. #y • it I ~.t 1: sA~ .~Tr. ~ (lc t~ S ti t~f i ~k Y i t 41. ti. Al. x ~P s O - S-