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OP RHTE# 4 q -5 -;fa -W2 Harnett County `Department of Public Health 24967 PERMIT # ,tI Deration Per 6t ©/New Installation Septic Tank Nitrification line ❑ Repair ❑ Expansion PROPERTY LOCATION: lq(ab 6uLr. P,t-arcyAti 21. (Stf 1. 496) Name: (owner) C c-,5fszo��Ajj2.2, SUBDIVISION LOT # System Installer: r) m Registration # Basement with plumbing: ❑ Garage�er of Bedrooms 44 Type of Water Supply: ❑ Community f]e'Public ❑ Well Distance from well r""feet System Type: 959, k - I-otl w., r1 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. Inas System has been Installed m compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization. . d 4f5n- say 0 WrP .e 1Z r4%i%•� quC�of .T ,\a�aau x PERMIT CONDITION - I. Performance: II. Monitoring: III. Maintenance: IV. Operation: Other. System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ No ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line Following are the specifications for the sewage di a system on the above captioned property. Type of system: ❑ Conventional cher � Eac J --1,-\��o Septic Tank gallons Pump Tank: , gallons Subsurface No. of,, II exact length -P,, 4S� width of depth of Drainage Field ditches 4 of each ditch I CX+, la feet ditches 3 feet ditches -1b inches French Drain Required: Linear feet Authorized State Agent Date !A.Sto ;015 I