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OPHTE# 16 - s --7401U Harnett County Department of Public Health 24664 PERMIT #�@ation Permi ep ticaNew InstallationTeTE Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: c t,.. J bc,lo 2�1 . C s n iva S-) Name: (owner) SUBDIVISION A..er-t LOT # r�O System Installer. Registration # Basement with plumbing: ❑ Garage Numb Bedrooms / Type of Water Supply: ❑ Community ublic ❑ Well Distance from well /00 — feet System Type: Z 4© (L,AL nS��_ 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 mmeliance with anolicable North Carolina General Stawtes. Rules for Sewaoe Treatment and nknnal. and .11 r.ndfdnn, of th. 1mn.--, P—i, .nd t .., .,Imn M11111 LUNUIIIUNS: I. Performance: System shall perform in accordance with Rule .1961. Il. 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 ❑ Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Iffier G/— Septic Tank: gallons Pump Tank: _ Subsurface No. of exact length width of depth of Drainage field ditches 41— of each ditch feet ditches 3 feet ditches French Dain Required: linear feet Authorized State Agent Date PWR Line gallons inches T'�tt i 'ZSiF� N�A,c--tro.� 0 h 17�z PAa2 i j J v W t3' tom' 24 , I y,3Kz x� A� c2Y Pum oa,vt M11111 LUNUIIIUNS: I. Performance: System shall perform in accordance with Rule .1961. Il. 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 ❑ Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Iffier G/— Septic Tank: gallons Pump Tank: _ Subsurface No. of exact length width of depth of Drainage field ditches 41— of each ditch feet ditches 3 feet ditches French Dain Required: linear feet Authorized State Agent Date PWR Line gallons inches V At A �f