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OP RHTE# ► 1-6- lag Harnett County Department of Public Health 24952 PERMIT # i9 eration Permit ,� New Installation © Septic Tank itriC�� fication Line ❑ Repair ❑ €: PROPERTY LOCATION: eg� _(S2 loll; Name: (owner) `xxAg Cs 7,.-, A. 14c m -a— , SUBDIVISION LOT # System Installer. CA (4- Registration # Basement with plumbing: ❑ Garageum�4-Bedrooms Type of Water Supply: ❑ Community uCYP blit El Well Distance from well e— feet System Type: I6: �' ii� =QO[L�Types V and A Systems expire in S years. (In accordance with Table V a) Ov Health Department 6 months prior to expiration for permit renewal. has been insmlled in compliance with applicable xonh Carolina General Sources. Rules for Sewage treatment and ^^POMP Tb 110 ✓-iP� trJ�" 4Y I ----�� �pY 5 i f °Tj a ao "Ilk I 64')( zl Y 5� d and all conditions of the Improvement Permit and construction Authorization. rtxrlll LUnUlll S: 1 ,p.-t-r%Ila Y> a—r> I. Perfor ce: 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 If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other. -k PAD 0(s-% QCL�STrr .y z-�SThLL � 131 � srs,Tsa�r. bri: rl ❑ D -Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line Following are the specifications for the sewage sal system on the above aptio eded f0perty. Type of system: ❑ Conventional they H Lo.� 1FI Septic Tank: F c �, � gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches T of each ditch ltd feet ditches 3 feet ditches I CC -1 inches French Drain Required: Linear feet Authorized State Agent Date e --q 11911 a0L3 -� rt' . K • r 5p t �1J1�