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OPHTE# `1-'S 10"61 Harnett County Department of Public Health PERMIT # Operation Permit 2 2 3 0 4 New Installation `Q Septic Tank"I ( Nitrification Line ❑ Repair ❑ Expansion Name: (owner) G, Zosv- 5,1.4 e'ratr. s System Installer: U-c,5 S--f a, c-,-a- Roa Basement with plumbing: ❑ Garage 'X Number of Bedrooms Type of Water Supply: ❑ Community X Public ❑ Well System Type: = (In accordance with Table V a) PROPERTY LOCATION: Nc;~-la SUBDIVISION Gw6a✓ OA~s LOT # 3 Registration # Distance from well 1®0 feet Types V and VI Systems expire in 5 years. Owner must contact Health Department 6 months prior to expiration for permit renewal. ims system nas peen installed in compliance with appucame North larolma t,eneral )tatutes, Rules for )ewage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. 6 t V a VN-'C'CL C.~v-CLC, rtRflff cunulnuNS: 1. 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 ❑ H201-ine ❑ PWR Line Following are the specifications for the sewage disposal s.YYstem on the above captioned property. Type of system: ❑ Conventional Other G~ ~LaW Septic Tank: ►C?O© gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches" of each ditch goo feet ditches 3 feet ditches inches French Drain Required: 1,GlhfieaT~et Authorized State Agent \~~y\\\\\\5 Date f 4 ~ -1 ' i ~77 y Y r r. f ~ _ ~ M ~ ~ 1 4 E! 4 t' Tfd ,.+r, N L J ~ A YS.. ~r+ ~ ,4 # ~t r ff A~ s y v t ~ ~J E , f . ~