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OPHTE# j —� 3`�` Harnett County Department of Public Health 23154 PERMIT #' Operation Permit New Installation X Septic Tank X Nitrification Line El Repair El Expansion PROPERTY LOCATION: �1��.z. L_Z-5 9-1 Name: (owner) v—i— C.t~ SUBDIVISION Q—K(IoUiNP. LOT # _ System Installer: 'Zv v�A Gs SV--q K- Registration # Basement with plumbing: ❑ Garage Number of Bedrooms L+ Type of Water Supply: ❑ Community Public ❑ Well Distance from well I enQ feet System Type: `T"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. Ihls 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 tAv LAS G Z c t� 6� v rrnrlu t.unuiiiums: I. Performance: System shall perform in accordance with Rule .1961. II. 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 ❑ H2OLine ❑ PWR Line Following are the specifications for the sewage disposal system on the above saptioned,operty. Type of system: ❑ Conventional \70i Other GHA.M, 3&Sj (�'�� Septic Tank: tOO O gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch S O feet ditches feet ditches Q,'— 3" F inches French Drain Required: Linear Authorized State Agent 7�' -�'�• _ �� �'`�� �_RL-0S Date 3111 13- 5 -3a�a5