OPFITE# oa-s Za, I, 90
Harnett
County Department of Public
Health 2 0 6 8 8
PERMIT #
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0 eration Pert
'
EJ New Installation L~ Septic Tank ❑
Re air nitrification Line ❑ Expansion
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PROPERTY LOCATION: ~P~css
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Name: (owner) C _ ~ o 0 Q.,
SUBDIVISION
LOT #
System Installer:
Registration #
Basement with plumbing: ❑ Garage
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❑ C
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❑ Number of Bedrooms 3
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ommun
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Public ❑ W
ell Distance from well feet
System Type:
177 C~
Types V and VI Systems expire i
n 5 years.
(In accordance with Table V a)
Owner must contact Health Department 6 months pri
or to expiration for permit renewal.
ims system nas been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization,
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewsdisposal system on & Bove captioned property.
Type of system: ❑ Conventional R Other re .e/ Septic Tank: /Oa (3 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a of each ditch 7- feet ditches feet ditches --Yc inches
trench Drain Required: Linear feet
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Authorized State Agen Date 7 )a') 43 ° 5
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CAcolina Huldiog, T't s •';0113
16 McKoy Town Road
NC 2832 r i 0:51) r 11t11.31
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T'ruci.t Gras,~: LD M W
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This load of tiro chips IS ff4m the Fuel Grade location and meats the Nc SpeclfFcaiiN as
stated In Innovative Wostswataf system upproval IWWS-2002-ON 10 1111* chip 4
UbsWuNaR to Rock Apgogals in'NiU ts:alioa Fields.