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OPHTE#C)`%Harnett County Department of Public Health PERMIT # aG3Co Operation Permit 21 8 6 0 New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: ~,4 C. 'v), ~j Name: (owner) 1,35:~\(-7mN,1Y1 FvUNr~ ~N t4. SUBDIVISION --~2c~y ~vcz1.~N~~ota LOT # 1 System Installer: R o c.~z y a ~l -S~,tv D Registration # Basement with plumbing: ❑ Garage ❑ Nm" etas 3~~ M Ern _ c N uo t a1 `eoo ~G~'s E N~ Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well 100 feet System Type: =1-1 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. ims system has been mstauea in compliance with applicable North t.arolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization. 5 6 E t~,~,> N 6 0 N ~ I I-<-_ N' 0 4 -5 V-1G ~ Eta ~'C 14 0 E1' to 2S MAN ~ rcnrut Lvnunlvlrz 1. 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 ❑ NoX If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other: ❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional Other Pvr.•e'Vo C^.2~i.c,~,, ~M~•>>~o } Septic Tank: Q050 gallons Pump Tank: 1 a;©0 gallons Subsurface No. of exact length vaav,•~~ r6rtt width of depth of Drainage Field ditches G of each ditch"1 dTt--, - Ca 6 feet ditches 2S feet ditches l6 " 3Lro inches French Drain Reauired: h Line Authorized State Agent ~-"k ~ k~ Date ti b\ )i ► ~ Tye t N`. r>Cr J N \ 1 f. a ~ Sit ~ wFq~Ti ~ ~ X N y . Z 5 i f t g. F 1 1 3 a i ~ r V h X o j ~i ter. ~ a 3 A c f° " ti ~ ~J r s ^ i, rs 116 " ~'Fi ~k n X Y Y" I$ Sf is e 47- eV, t i T f.~ 110