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Harnett County Department of Public Health 2 0 5 5 2
PERMIT # aLi ciOJ~ Operation Perftllt
New Installation X Septic Tank ❑ Repair>; Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Ppu►- F~~~ -Cy SUBDIVISION -rte o Low LOT # 4W
System Installer. Q ~3 S-caxtt-Lf ~D Registration #
Basement with plumbing Garage Number of Bedrooms
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well ~ 0 b feet
System Type: ~1> 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.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
gi}L`.+~illt ~hN,GO~ 1~ *S'SQT$tr'S IC1 N Ld
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: 11 Conventional Other P. ~eT•Z Septic Tank: I o e e, gallons Pump Tank: t004 gallons
Subsurface No. of exact length a'tk G S ; width of depth of
Drainage Fi of each ditch 3x14S feet ditches 3 feet ditches I_ inches
French Drain Reauired'~-- _ n reet~
Authorized State Agent -NNI" Date
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