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OPHTE# ) -s-q11 Harnett County Department of Public Health 24697 PERMIT # 29y -k -Operation Perm � © New Installation Septic Tank CYNitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: Uxforc) wcxeSs Oe. (C)1,4 's&:' a -A - 54 ICY -0 Name: (owner) GnmGar-(-_ t Ic> rc a T , . SUBDIVISION C2x Fo r—,k LOT # S System Installer. (L _l 1 Registration # Basement with plumbing: ❑ Garage Nu er of edrooms 3 Type of Water Supply: ❑ Community ublic ❑ Well Distance from well �"�� feet System Type: s . —441r5 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 insulted in compliance with applicable North Carolina General Statutes, 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. 7 i S' I'ar a �� ual off aNA"15E sc' 11 C ho M WX% per" �OC3) - wind a end pie�cs +ir vr.�� 113$1 'L. A I� I OFtK e. it I1K1 '� — 3A2 5 I V .�Su ITA rSl. rt , J..a$urTAOf.�' S 61 L iUll Fo (L r, wr:,a aS OR. System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other. Subsurface system operator required? Yes 240 ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting. ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PAIR Line Following are the specifications for 1 the sewage� posal s stem on the above captioned property. Xf Type of system: ❑ Conventional G�Other c l v) his p Septic Tank: 106n gallons Pump Tank: I GCS gallons Subsurface No. of exact length width of depth of Drainage Field ditches 3 of each ditch feet ditches - feet ditches �7 inches French Drain Required: Linear feet Authorized State Agent Date �?61 04 ol a