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OPHTE# 15 -57-1 Harnett County Department of Public Health 24010 PERMIT # Operation Pry New Installation )S� Septic Tank Nitrification Line ElRepair El Expansion �` PROPERTY LOCATION: 41r y 40 Name: (owner) �ar on : 1 10rs`S )r' SUBDIVISION MatLOT # al System Installer: Registration # Basement with plumbing: ❑ Garage Number of Bedrooms 3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 D6 feet System Type: =Za Types V and VI Systems expire in S 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 Norah Carolina General Stamte4 Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Audsonealion ` 1 ®�r�`= a� o w('fy D 2 1 V PERMIT CONDITIONS: I. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule .1961. 111. Maintenance: As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ Nqx If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: p V. Other. R) (.if .a g6s3skwyE e' ?a12fle,6Tel C)r-I— D-Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ Following are the specifications for the sewage disposal stem on the above captioned p erty. Type of system: ❑ Conventional Other l_1;cVAIm, � IS:.J+��'� Septic Tank: �©d0 gallons Pump Tank: Subsurface \ Noof exact length width of depth of Drainage Field f of each ditch 0 feet ditches 3 feet ditches awl French Drain Required: linear feet Authorized State Aeent ��� �-D Date at 15 " PWR Line gallons inches rs-s �0-3