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OPHTE# } 0~5 ~3g~3 Harnett County Department of Public Health PERMIT # Operation Permit 21 5 6 6 X New Installation 'X Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: mp&,ts V-0 Name: (owner) R, Ni, L SUBDIVISION hEFOgp LOT # System Installer kE-> ~26w11-4 Registration # Basement with plumbing: ❑ Garage )5~ Number of Bedrooms Type of Water Supply: ❑ Community P5\ Public ❑ Well Distance from well 100 _ feet System Type: --7T-T-r ~ 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 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. 1U " t weep T o _ 1 C tuNVf:NT~Of`j^j- t R,,~pa~ci A2~ }g d 3 ~~narM 'S F~v uSE D E Loo-yW-00 P~ DFRMIT rnkinlTIAW L 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 ❑ No X If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other ❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional I Other PvMp t G~c.rsc3 Grz Septic Tank: t©od gallons Pump Tank: bod gallons Subsurface No. of exact length width of depth of Drainage field ditches _ of each ditch f ao feet ditches feet ditches inches French Drain Required: line,t0eet Authorized State Agent N.-"' ' Date -TIZLI\ c R s,.,~, • ~ ate`, - r w 2 Nam . t 1 Y ' c l ~ 1. ,~•L, , ~ '~i Y Y ,g