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OPHTE# ~T- S-1a0 Harnett County Department of Public Health PERMIT # 2-G-7 ® Operation Permit 2 2 71 1 New Installation '6~ Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: -N~ '~n Name: (owner) ~Mzj~L\c,t m `ko n- yM SUBDIVISION `I ~oN NEE LOT # System Installer: Registration # Basement with plumbing: ❑ Garage1 Number of Bedrooms -3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet System Type: 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. tms sys[em nos oeen instaoea in wan appncaoie nor[n Lamina uenerai mamtes, nuies nor sewage treatment ana i 1 tLEPA~R ~ r r i.)OJZG I~ ve ana an conmuons in me improvement rermtt ana t.onstrucnon Autnor¢atlon. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule .1961. If. Monitoring: As required by Rule .1961. III. Maintenance: As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ Nox If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other: ❑ D-Box ❑ Following are the specifications for the Type of system: ❑ Conventional Subsurface No. of Drainage Field ditches French Drain Reouired-.*,,'1z--_ Pump ❑ Alarm ❑ H20Line ❑ PWR Line sewage disposal system on the above captioned property. Other L r.NP 1 d I; 2-- L Al Septic Tank: t d©~ gallons Pump Tank: 1 O o O gallons exact length width of depth of beach ditch `a Oy feet ditches 3 feet ditches inches Authorized State Agent 9.~~LS Date ►1 I