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HTE# o~-S 1,37942 Harnett County Department of Public Health
PERMIT # d q o,3 Operation Permit 22031
New Installation 0 Septic Tank Er Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W~ ~e S~~ ~e,t✓~~t
Name: (owner) _Z) c,y! c1 C',Cr a ~ -,sr SUBDIVISION F,' LOT # __7
System Installer: , 7s r- A M c_+4-k,- , l Registration #
Basement with plumbing: ❑ Garage Z Number of Bedrooms
Type of Water Supply: ❑ Community IB/ Public ❑ Well Distance from well feet
System Type: a (7, 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.
iris system nas oeen instanea in compnance witn appucaote nortn carouna beneral statutes, naves for )ewage treatment and Uisposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other )5" Z.F/o.~ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch J G 5 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
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Authorized State Agent l f~ ' V Date C'~ ° 6
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