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OP RHTE# 0 g- ---.I W5~1 Harnett County Department of Public Health 2 0 6 9 2 PERMIT # yZ S'~Z-7,7 Operation ~Permit V'New Installation EI Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: !V1 C.r-kr 4. Name: (owner) 1 ~•o. ~~r _QeJr SUBDIVISION A-1,J1, -e( LOT # /3 System Installer i e A Q r~_ Registration # Basement with plumbing. ❑ Garage 2"'Number of Bedrooms Type of Water Supply: ❑ Community C Public ❑ Well Distance from well feet _Y7 G System Type: 11 r 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. ms sprem nas Deen mstanea in compliance with applicable north t,arolrna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. to 3E fwK. ~ C_"el G k r4L /;W9 J'-, c~~kttl ,v,j, W o r I l:. Q C J 1 rr:nnn wnvlnvm>: 1. Performance: System shall perform in accordance with Rule .1961. ll. 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. Following are the specifications for the Type of system: ❑ Conventional Subsurface No. of Drainage field ditches seewway disposal system on the above captioned property. L~' Other (Z.) c.k- Septic Tank: LOG d gallons Pump Tank: gallons exact length width of depth of of each ditch eZ feet ditches 3 feet ditches A '3 inches French Drain Required: Linear feet c Authorized State Age ~T~ Date - / ire © 9-,5=a17Tre i~ G l Ala k • 4 Je, WO ~ x Y 141 Y # F ~ ~ s A O `t ' S' L 1 7ryl- r d r 1~~1 6p;` w.y~q»ylta v{ nwwre~' t~ . ,ems a~. .