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OP RHTE# Ito -5-VaH3'qr2 Harnett County Department of Public Health 24655 PERMIT # Ouration Permit,- LrYNew Installation Iff' Septic Tank 13-1rtrification line ❑ Repair ❑ Expansion PROPERTY LOCATION: ^—Yi S6tJ Name: (owner) 0\04 ', N ?Pre? SUBDIVISION LOT # _ 4 System Installer: Registration # 1914 Basement with plumbing: ❑ Garage ❑ Number of Bedroo Type of Water SuppF -. ❑ Community ❑ Public ell Distance from well /o O feet LPrtoR�FJ,) System Type: ,A S s - Types V and VI Systems expire in S 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 PJM? TU Zs i� Artxatrro^' Pe^t;^5 Farre ��e�\ sr l OC7F•E. e^d n oCk L own C'0 v rw gas ipB ���Ey—F�i�� `l I ''(62 pw n Yl r• P \ &•T __ y�j -S� d ha D�a I y T o aL 55 w PERMIT CONDITIONS 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 ❑ No 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 sal system on the above captioned property. Type of system: ❑ Conventional Other G ,> ~.131::6 Septic Tank: 1`2vta gallons Pump Tank l zt-g�!s gallons Subsurface No. of exact length width of depth of Drainage Field ditches '4 of each ditch 6e�) feet ditches 3 feet ditches 21 inches French Drain Required: Linear feet Authorized State Agent /✓�,�� Date ©-4 A-g- IN 0 f. 0