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HTE# Q' - a3ff;~N Harnett County Department of Public Health 21 114
PERMIT Operation Permit
New Installation '~K Septic Tank ❑ Repair( Nitrification Line ❑ Expansion
PROPERTY LOCATION: N.1LtnP,w
Name: (owner) SUBDIVISION LOT #
System Installer: ~3~zcw~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public '1 Well Distance from well 1 Ob feet
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System Type: ~-a ,cw lr G
Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must 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 Construction Authorization.
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PERMIT CONDITIONS:
I. 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.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned propersty
Type of system: ❑ Conventional Other G , c-v-- 4 LAkn66 a Septic Tank: k000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch (~O feet ditches -3 feet ditches a'}`3L5 inches
French Drain Required: Linear feet
Authorized State Agent Date tt 30