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OPHTE# o1-5-)614 1 Harnett County Department of Public Health 21 4 8 8 PERMIT # aLA°t 10 Operation Permit X New Installation IN~ Septic Tank ❑ RepairrX Nitrification line ❑ Expansion PROPERTY LOCATION: LGL,-^uEA_ a~n~vc izp Name: (owner) )iAo w ~zL ~_:fl w p cz,as SUBDIVISION Gr~c E.w LS s LOT # 15 System Installer: C ,s STn~Gw~aNO Registration # Basement with plumbing: ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community ( Public ❑ Well Distance from well G©b 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. 1> spiem nas Deen mstanea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. tC)' SQ-460t, tau-bss FPsCr r: 25 10 Gov ~QN t r-'$S NOVSts D h t v G s4n6SSC3u(LG [`N- PERMIT CONDITIONS: I. Performance: If. Monitoring: III. 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. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Other L_ -L Low Septic Tank: X00 0 Subsurface No. of gallons Pump Tank gallons exact length width of depth of Drainage field ditches- of each ditch feet ditches 3 feet ditches IS inches French Drain Required _ r..,,.,._ r,.,,,. Authorized State Age Date C