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OP RRRHTE Harnett County Department of Public Health 23750 PERMIT # Operation Permit New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: 'i"1 c.e, uC�-P�.a 9 Name: (owner) ® �i© .g,V>f� 2� SUBDIVISION SUTn0-,LOT # System Installer: P,4—V i Registration # Basement with plumbing: ❑ Garage X.Number of Bedrooms Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1(nO feet System Type: =b 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. This 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 rtnrnl t.UIVUIIR NY 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 cc IV. Operation: V. Other: itions, maintenance and reporting. ❑ D -Box ❑ Pump ❑ Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional X Other � -;—' a—; , y Subsurface No. of exact length Drainage Field ditches of each ditch feet French Drain Required: Linear feet Alarm ❑ H2O1-ine ❑ PWR Line Septic Tank: i gallons Pump Tank: gallons width of depth of ditches feet ditches inches Authorized State Agent ��) Date i � �-� � - '�� �S�i2�tz.