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OPHTE# la -5- 10 Harnett County Department of Public Health PERMIT # `� } 0 Name: (owner) System Installer: Basement with plumbing:. Garage ]N" Numbe Type of Water Supply: ❑ Community )5, Public System Type: M11 (In accordance with Table V a) Operation Permit 22757 New Installation -K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: C.. -I caws C—, C- SUBDIVISION �= IPc�Cs �o t LOT # U� G Registration # r of Bedrooms L-) ❑ Well Distance from well 1O 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 mstanea in compliance with applicable North tarohna t,eneral )tatutes, rules for )ewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. PERMIT CUNDIIIUNl: I. Performance: System shall perform in accordance with Rule .1961. 11. Monitoring: As required by Rule .1961. 111. 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 ❑ Following are the specifications for the sewage disposal system on the above captioned property. Type of system: El Conventional Other 9u�+971 5,7 -�I-W Subsurface do. of exact length Drainage Field ditches of each ditch MC) feet French Drain Required: ti _ —Oear feet Alarm ❑ H2OLine ❑ PWR Line Septic Tank: to O a gallons Pump Tank: �.o ©o gallons width of depth of ditches_ feet ditches inches Authorized State Agent 5 Date i`�-1 t "i 11;- i a— S -ag—°i ) o