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OP RHTE# I 0-'5-_--AM'Q_ Harnett County Department of Public Health PERMIT #Operation Permit 21 9 4 4 l New Installation A Septic Tank;)4 Nitrification Line ❑ Repair ❑ Expansion Name: (owner) System Installer: Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well System Type: a (In accordance with Table V a) PROPERTY LOCATION: tL~s E_ )NE4km SUBDIVISION LOT # Registration # 3 Distance from well 1©O feet Types V and VI Systems expire in 5 years. Owner must contact Health Department 6 months prior to expiration for permit renewal. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization C~ t ~'s •a x30 I~ PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule .1961. ll. 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: eqS-' UL711 65 F~ZFN1trC 'R204t\ SZ FPI Ia-, R QU}P G rryE~t~ ❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line Following are the specifications for the sewage disposal system Co-n+ the above captioned property. Type of system: ❑ Conventional A Other EZ RI-OW Septic Tank: W)0 0 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field - I cues - ~ of each ditch 60 feet ditches 3 feet ditches ali inches French Drain Reauiredx-_ feet Authorized State Agent Q.&A Date ILAI 'In r m r Q - F r ~ yy e , S