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OPHTE# I Harnett County Department of Public Health PERMIT # Operation Permit 21 8 7 7 New Installation )R Septic Tank X Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: Name: (owner) ~\1.-~es:-Ls,,,o Sso SUBDIVISION 5}JOe2or LOT # 3 System Installer: REG1rc~-d] Registration # Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well la O feet System Type: -=C' 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 with applicable North Carolina General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the rerm¢ and Lonstrucnon Aumonzanon. 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 ❑ No X 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 property. Type of system: ❑ Conventional I Other --E sz.f; P S Septic Tank: t0®© gallons Pump Tank: gallons Subsurface No. Of exact length width of depth of Drainage Field ditches - each ditch a Q feet ditches 3 feet ditches 3C- T? inches French Drain Required. Linefeetoo~ Authorized State Agent___ Date 4 t _ t fi ~ J 0 L - x t , n~ S 4~~J-a~'31ti-► ,-I w e vw F - e