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' as Harnett County Department of Public Health 2 0 5 8 6
PERMIT # S 3 Operation Permit
New Installation M Septic Tank ❑ Repair(, Nitrification Line ❑ Expansion
Q .1 PROPERTY LO(ATION: V\35
Name: (owner) 116 ca 1'a~ j'h SUBDIVISION LOT #
System Installer: ~tc\ . Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Su ly: ❑ Community Public ❑ Well Distance from well feet
System Type: 2 \C,, V Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiratio for permit renew.
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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 ermit and construction Authorization.
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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:
V. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation onditions, maintenance and reporting
Following are the specifications for the sew a disposal sy em on Pte above captioned property.
Type of system: ❑ Conventional he, `0~j Septic Tank: 2 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: linear feet
Authorized State Agent _ Date l1
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