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Harnett County Department of Public Health 21 1 0 3
PERMIT # a-S~S Operation Permit
1 New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: n o< ,t* V-o
Name: (owner) SUBDIVISION LOT # L
System Installer: -T-EC,
Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _2
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: -UT I 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.
[his 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 Construction Authorization.
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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 ❑ No/1~4'
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 0u%c NL- 4- CHA r,8 Septic. Tank: IOO d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch b feet ditches 3 feet ditches alt-30 inches
French Drain Reauiredr, r fop
Authorized State Agent : ' ~~d~~ e41)5 Date ►s 1 r,101
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