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OPHTE# 1-5- Harnett County Department of Public Health PERMIT # cob-736 Operation Permit X New Installation J~k Septic Tank X Nitrification Line ❑ Repair El Expansion PROPERTY LOCATION: pq-.` Name: (owner) rn3e<2)- -C) '~40"az SUBDIVISION ~SNA Fay.A LOT # 1 System Installer: V> 4-0w+,.a Registration # Basement with plumbing: ❑ Garage Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well \©C7 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. I. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule .1961. 111. Maintenance: As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ NOI If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: Other: ❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line Following are the specifications for the sewage disposal system on the a ove c 'oned property. Type of system: ❑ Conventional Other C N4"SfxQ- t~-\' Septic Tank: IWO gallons Pump Tank: gallons Subsurface Drainage Field o. ditches exact length of each ditch t5 ® feet width of ditches 3 depth of feet ditch OIy-Y) French Drain Reauired: h C~ rr.l ar es , inches Authorized State Agent `*NI Date a v 1 or' r ~ f . -s f 1~- a✓.. O~~ 1~ I Gd\ S n j r , I , vy ~ " ~f