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OPHTE# (O-~v~~t 14~►2 Harnett County Department of Public Health 21 4 9 9 PERMIT # a Operation Permit New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: M Name: (owner)~~ G1) n, r, t a G5 SUBDIVISION ~'s'A EF'or~ LOT # System Installer: 1s ~c~ ors t) Registration # Basement with plumbing: ❑ Garage Number of Bedrooms - Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 0 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. [his system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. 7V~--A . D 34 rt t V E PFaMIT rnNnITIM. 1. Performance: II. Monitoring: III. Maintenance: IV. Operation: V. Other. 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 Following are the specifications for the sewage disposals stem on the above captioned property. Type of system: ❑ Conventional Other C ~Lp~ l Septic Tank: ~©dd gallons Pump Tank 100 O gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch D feet ditches feet ditches 1--- inches French Drain Reauired I;--f-f Authorized State Agent b Date 6 Z,1 w p sK F ~ a 1 '^!ylRJ to TF' r r~~~ i r£~4. Air 8~ r as A P_ t 1 ~ a 3 a a t0-5 ao~i2 a F k~ 4 F, _ rr f y 3`s 4 Ha ~ t.