opHTE# 09 -5- a-M$y Harnett County Department of Public Health 2 0 7 0 2
PERMIT # e2 9 Q e~ ration Permit
New Installation R /Septic Tank ❑ Repair i2r' Nitrification Line ❑ Expansion
PROPERTY LOCATION: L. a sso.. a f- KJ,
Name: (owner) SUBDIVISION Grpjt LOT #
System Installer. 01-k Registration #
Basement with plumbing: ❑ Garage [Number of Bedrooms
Type of Water Supply: ❑ Communi VPublic ❑ Well Distance from well feet
System Type: c, Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
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 Permit and (onstruttion Authonzation.
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PERMIT CONDITIONS: Co
1. Performance: System shall perform in accordance with Rule .1961.
II. 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.
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IV. Operation:
V. Other.
Following are the specifications for the sew~oisposal system on the above captioned property.
Type of system: ❑ Conventional Z Other Z >/ov7 Septic Tank: /C~700 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches i of each ditch J. 0 feet ditches 3 feet ditches inches
french Drain Required: Linear feet
Authorized State Agen Date 111120 0 7
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