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OP RHTE# �� °J3�J °LSZ, Harnett County Department of Public Health 23521 PERMIT # :�L__) D Operation Permit New Installation 'T�k Septic Tank Nitrification Line ❑ Repair ❑ Expansion L PROPERTY LOCATION: Name: (owner) cA -tAE 'I 't - �aes�4y SUBDIVISION �'��m� 1,cv,G �s- star�S LOT # System Installer: C>7�N-_-) srL-,C,-c.A, Registration # Basement with plumbing: ❑ Garage `K Number of Bedrooms _ Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well LbI�) 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. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the 1 rovement Permit and Construction Authorization. 6ZE4 n• � n, �2�6s ® 6 6 tivoa PC; D 33 I�C3V D 4� t C rcnrui Lvmuiiwiij. 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 ❑ 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 E `Z., Septic Tank: t ®© 0 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches 3 of each ditch 100 feet ditches feet ditches R inches French Drain Require Linear feet Authorized State Agent Date 1 k1 14 Li 13 - 5 -3> 5'1 O,V-