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OP RHTE# 13 — Harnett County Department of Public Health 23035 PERMIT # a__7 9 3 Operation Permit New Installation 'X� Septic Tank X Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: Po,4c)F_sL ©s 2, 910 Name: (owner) C. �Aosns* SUBDIVISION LOT # I System Installer: 'T-,o RQ� w N 5 Registration # Basement with plumbing: ❑ Garage � Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well C ®44 feet System Type: t 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. PERMIT CONDITIONS: I. Performance: 11. Monitoring: 111. Maintenance: IV. Operation: V. Other: System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ No ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting. ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line Following are the specifications for the sewage disposal system on the above captione} roperty. Type of system: ❑ Conventional Other �-�" Septic Tank: Q gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditc ees'' of each ditch S S 53 feet ditches feet ditches inches French Drain Required-- \ Authorized State Agent ����"��� Date to i 3 - 5 - 3OQPVQ .