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OP RHTE# Harnett County Department Public PERMIT # —g):�6l-D-4 Operation Permit New Installation `K Septic TankX Nitrification Line ❑ Repair ❑ Expansior _ PROPERTY LOCATION: '\-I tiL_Ue, Name: (owner) SUBDIVIS10N Z5•-+e,(-':� P, C -,Q, LOT # I(, System Installer: Registration # Basement with plumbing: ❑ Garage �' Number of Bedrooms _4 Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1® O 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 Improvement Permit and Construction Authorization r i P > rL i R rtKMII LUNUIITUNS: I. Performance: System shall perform in accordance with Rule .1961. If. Monitoring: As required by Rule .1961. III. Maintenance: As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ N If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other: ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ Following are the specifications for the sewage disposal system on the above captionedproperty. Type of system: El Conventional � Other C�-\P\'r\bc Septic Tank: 1"0 gallons Pump Tank: Subsurface No. of exact length width of depth of Drainage Field cy1 hes--..._ I of each ditch Q feet ditches 31 feet ditches French Drain Required: � `"�-,Linear feet Authorized State Agent \�� \���'' � =� __ Date u-iI) �� PWR Line gallons inches li- 5-3tn3a?,-