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OPHTE# S O'S�`y� Harnett County Department of Public Health 25049 PERMIT # a61$ ` Operation Permit New Installation X Septic Tank X Nirification Line ❑ Repair ❑ Expansion Q PROPERTY LOCATION: QvaQr aGsaa Name: (owner) S,01 G • }�9ertGFO� SUBDIVISION LOT # System Installer: 2Ectv1�C Registration # Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -- Type of Water Supply: ❑ Community�L Public ElWell Distance from well feet System Type: a] Types V and VI Systems expire in S years. (In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal. mis eyaem has peen installed in mmpluam with applicable North Carolina General Statutes, Rules for Sewage Trea nt and Disposal, and all conditions of the Improvement Permit and Construction Authorization, i i C4 e; �O 1 T 15" 4A or�C- N 9 fJPoszoCAa CCP Authorized State Agent nr'A3 Date I. 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 ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other. ❑ D -Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line Following are the specifications for the �sew,(age disposal system on the above optioned @�operty. El Type of system: Conventional Other - Sfr i&(yL L©y J Septic Tank: s 000 gallons Pump Tank: gallons Subsurfac Nd. of exact length width of depth of Drainage Field� 3 of each ditch feet ditches 3 feet ditches JV -AO_ inches French Drain Recut Linear feet Authorized State Agent nr'A3 Date � da r r `.N t i � 1