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OPHTE# o-~ --s ';~')a Harnett County Department of Public Health 21 51 2 PERMIT # a 565 Operation Permit New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: PoavpF W5 CLD Name: (owner) ~SEct,r.ACL~ ~-l 0 rh Lz SUBDIVISION CAn ai Spa ,,,5 LOT # i aR, System Installer: HAa.oLO G~,~rs.~~ Registration # Basement with plumbing: ❑ Garage 'f;l Number of Bedrooms 3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well S ©a 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. 11m srsnem nas Deen msranea in PERMIT CONDITIONS: I. Performance: II. Monitoring. III. Maintenance: IV. Operation: V. Other: with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, 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 ❑ No'M If yes, see attached sheet for additional operation conditions, maintenance and reporting. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Other 1 -cub G\\ 15 Septic Tank: 40 a gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches T of each ditch S S'd feet ditches 3 feet ditches inches French Drain Required: Linear feet Authorized State Agents Date JUL- (-dUlU lb:.514 FKUM: HHKULUCHK I tK i A ~r 19 m o e ~p$ » ~B e or 9104855052 T0:9108939371 P,1/1