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OP RHTE# 10--S--a cx~oQ- Harnett County Department of Public Health PERMIT # a"rv3n 2- Operation Permit 21 8 61 New Installation 'X Septic Tank K Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: NC, a-105 Name: (owner) _Gp,2y ~o~»~dr1 SUBDIVISION LOT # 5 3 System Installer: G-c,-~ Registration # Basement with plumbing: ❑ Garage Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well Lc G 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 C&Pa.General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization Hd "`6oL~D P iPE J 8Cf C5 ~ItisJ ~ aS°ta i ~u f \ct) 3a~ U6 t c I 'Mil IUNDIIIUNJ: 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 ❑ 1120Line ❑ PWR Line Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Other 2- ~LVw Septic Tank: L©00 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditche of each ditch a~0 feet ditches 3 feet ditches 1% inches French Drain Reauired: tfeet Authorized State Agent RG" Date