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OPHTE# ) 7 —6 - Harnett County Department of Public Health 24684 PERMIT # 'Z.Cf4�) eration Permit. LeK New Installation � _ Sgptic Tank a Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATIO . La VA-,�e_ a N C sr., yvu3 Name: (owner) SUBDIVISION LOT # System Installer o e.3 3 Registration # Basement with plumbing: ❑ Garage umb of Bedrooms 3 Type of Water Supply: ❑ Community ublic ❑ Well Distance from well feet System Type: 7 5i2 r% -cI;K�Ei 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. Ims system on been installed in compliance with applicable aordt Carolina General States, Rules for Sewage treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization PERMIT CONDITIONS I. Performance: 11. Monitoring: III. Maintenance: IV. Operation: V. Other. j 23s zs%dam.- 2sAgy,2 0 6 M 43' © Js, I I WO' 1 qi 1-r 3pn 5� LAFAYer—ITC� etre S2 14 V\3 System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ No ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting. ❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line Following are the specifications for the sewage dis osal system an the above captioned pro erty. Type of system: ❑ Conventional cher i c{ Ghc,. be -r— -. Septic Tank: cCX:Y-) gallons Pump Tank /C� gallons Subsurface No. of exact length width of depth of Drainage Field ditches 3 of each ditch q6' feet ditches feet ditches l8 inches French Drain Required: Einar' feet Authorized State Agent 40�%- Date /12/ v ct d' 4 .✓ ,,1i � ti �� - � �: �.;. �� � v ' _.