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OPHTE# ©8-J-J 0-D 11~ j3 Harnett County Department of Public Health 2 0 6 2 4 PERMIT # u 91 Operation Permit New Installation~_Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: f 11 Name: (owner) C0M~' cl J SUBDIVISION- A J~z r LOT # System Installer: 162 & -'Ji-- ^ Registration # Basement with plumbing: ❑ Garage ~4 Number of Bedrooms 3 Type of Water Supply: ❑ Community >1~ Public ❑ Well Distance from well feet System Type: L, _ f tl L-( AE L Types V and VI Systems expire in 5 years. (In accordance with fable V a) Owner must contact Health Department 6 months prior to expiration for permit renewal. lms 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. f r j /0,, v~ t r f3 J nrnmr rn~lmm~ur 1 LI\111f W11VIIIVI\J. 1. Performance: II. Monitoring: III. Maintenance: System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other IV. Operation: V. Other: Subsurface system operator required? Yes ❑ No ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional `'Other ; ) L., t tr '-f Septic Tank: J 2 J gallons Pump Tank: gallons Subsurface No. Of exact length width of depth of Drainage Field ditches t of each ditch feet ditches feet ditches IK inches French Drain Required: Linear feet Authorized State Agent Date n1 - 3 - 0 1 y U t. pT. 4. f 3 ~ 4 4 ~ d t ' i° ' .4 t sY `'~y ~ P a Si W y ■