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OPHTE#~0 - o~-5 Harnett county Department of Public Health PERMIT # Operation Permit 21 7 9 0 New Installation 18\ Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: "GCS -,,j Name: (owner) C vf,Y\ n.;.P.I-,A SUBDIVISION LOT # System Installer: 16 cu:),~ r--j Registration # Basement with plumbing: ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well kOQ 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. A S /%V P ~ f ~ ~oJSG E A I£ JS n $d~ PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule .1961. 11. 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 ❑ H20Line ❑ PWR Line Following are the specifications for the sewage disposal system on the above captioned perry. Type of system: ❑ Conventional Other C,x-,1>,nR ( V)C-Y-~i Septic Tank: t©Od gallons Pump Tank: gallons Subsurface No. of exact length width of depth of 01 yA Drainage Field ditches Ut of each ditch feet ditches 3 feet ditches 1 inches French Drain Reouired~,_ Authorized State Agent ~~zc Date t.\ , k' ~ L Z A, Y p 01 1 p ti 6 1~ ~ . is.' ~ y } ~ ` l . ^ d i 9 " 1 `S. fAr"' 7 MTV Y... L,. v $,n >Y/ g4n1L $~I ~i till u. POP lie ell d, i € 1 i o p, 3 t n S WIS WWI 77 o mit d ~ S