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OP RHTE# Harnett County Department of Public Health 23670 PERMIT #7 Operation Permit New Installation "X Septic Tank Nitrification line ❑ Repair ❑ Expansion PROPERTY LOCATION: uc-4— i Paa -Y Lr3 Name: (owner) ``v�Y �,�—�n.�c-'S��v ANG SUBDIVISION �o—,l Qgz Q-.,QG£ LOT # a9 System Installer: b qm = © Registration # Basement with plumbing: ❑ GarageX Number of Bedrooms Type of Water Supply: ❑ Community N Public ❑ Well Distance from well i ® 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 X33 1`50 (p'f i -o V Q ro 't Ytf it IUNUIIIUN): I. 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 Following are the specifications for Type of system: ❑ Conventional SubsurfaceNo. of Drainage Field * ~� vitcW French Drain Reauired: ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line the sewage disposal system on the above captioned property. Other P'v-M#-i o 2 �i c -,,r Septic Tank: 10 ®® gallons Pump Tank: t ted gallons exact length width of depth of of each ditch - feet ditches 3 feet ditches 1'qX-� inches Linear feet Authorized State Agent Date