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HTE# J'-,S-D ~r6s3 Harnett County Department of Public Health 2 0 5 8 7
PERMIT # Operation Permit
IZQNew Installation P~-1iptic Ta k ❑ Repair'~Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) C~n~ SUBDIVISION ,ter c r~ c L LOT # '4 '3
System Installer: , 0-( Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ~4--Public ❑ Well Distance from well feet
System Type: C- 2 F1 ai 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.
5a v\1A\
imS system Ras oeen mstaneo in
MMIT rAL AITIA11t.
cat
with
North larolma General Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization
amp
1. Performance:
II. Monitoring
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No 16
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sewage disposal sNem onehe above captioned property.
Type of system: ❑ Conventional L Other Z t' Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of ,
Drainage Field ditches of each ditch feet ditches , feet ditches ~ d4 inches
French Drain Required: _ Linear feet
Authorized State Agent-A---- Date U~--3-~- Dcl
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