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OPNTE# iG s t 1�S ") Harnett County Department of Public Health 24616 PERMIT # oi�1�3) Operation Permit New Installation '1;& Septic Tank 19( Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: Nual Q.p Name: (owner) '%AS"cAp ��rea9,,CXv9.S SUBDIVISION % 9a' ns S -ACLS LOT # V"t— System Installer:_1 P-0 OQb 1 N Registration # Basement with plumbing. ❑ Garage Number of Bedrooms z-] Type of Water Supply: ❑ Community �R Public ❑ Well Distance from well feet System Type: �.� 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 North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoriaanon PERMIT CONDITIONS: I. Performance: 11. Monitoring: III. Maintenance: IV. Operation: V. Other. s ? r al 7 �.,S6rE > 1 y o I a a 1 ©� If a 1 G-4 ev-55 0 1 - 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 ❑ D -Box Following are the specifications for Type of system: ❑ Conventional Subsurface No. of Drainage Field s French Drain Remitted: maintenance and reporting. ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line the sewage disposal systemyn the above cap OtheruG' l o CN gallons / 506 0 exact length width of depth of 1Q of each ditch Ai 00 feet ditches_ feet ditches a inches \ Linear feet Authorized State Agent\�.��� kc 3�3 Date '7 10