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OP RHTE# I46 -5-a+317301— Harnett County Department of Public Health 9A1 51 PERMIT At 'O yb34 OOwation Permit __ L4"New Installation C''Septic Tank C�NTri If c on Line ❑ Repair ❑ Expansion PROPERTY LOCATION:_ '315 sr- oc)0 Name: (owner) 3vb6n+ Tes5<m T(A IrtiM� s SUBDIVISION LOT # System Installer. , ed Pit—v..xn Registration # Basement with plumbing: ❑ Garage E❑ N�bumb Bedrooms q-- Type of Water Supply: ❑ Community LJlic ❑ Well Distance from well iCb i feet System Type: � rc, a , �. s � 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 nas been installed in compliance with applicable North Carolina General Stamus, Auks for Sewage Treatment and Dispoul, and all conditions of the Improvement Permit and Construction Authodzation. { Q bei`trcn A S w rvAA Ons;.6, Ir S.y5v"X Si2C.a cor e.l. 4.ed CVcir./a l I' I. It 02r v F r tY H©rt swra.N Il���j � SyJM Al H I PERMIT CONDITIONS: Performance: System shall perform in accordance with Rule .1961 Monitoring: As required by Rule .1961. Maintenance: As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ No fY 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 seewwageiposal system on the above captioned ro erty. Type of system: ❑ Conventional 7 ther Ciq C l�rytlz T ,, Septic Tank IUCX--) gallons Pump Tank: Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch S 'S 0 feet ditches 3 te.r Ainh., t 5oN 7i. PWR Line ..A gallons French rain Required: Linear feet mw Authorized State Agent � Date 00t It's IAU' $ I Ai co