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KE# f -+11~ 7- Harnett County Department of Public Health 19980
PERMIT # , w Operation Permit
- New Installation -E;' Septic Tank ❑ Repair o Nitrification Line ❑ Expansion
Name: (owner) J,/\ PROPERTY LQUTION:
«t SUBDIVISION LOT #
System Installer. S VrA" 4 Registration #
Basement with plumbing. ❑ Garage U~, Number of Bedrooms Z
Type of Water Supp K ❑ Community [~S Public ❑ Well Distance from well _ feet
System Type: I --A j :Z~ y Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) ( N c 3 ` Owner must contact Health Department 6 months prior to expiration for permit renewal.
Itns system has been mslakd in compiaNe with ipphraW Norsk CxoMu Gerwj SututM Auks for Sew Treument W Di ud all conditions of the Impro.emmt Permit ud Construction Authoriutkn
~c r
PERMIT CONniTInNt,
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 7o
IV. Operation:
Y. Other
maintenance and reporting.
Following are the specifications for the a disposal sy; em n the above captioned property.
Type of system: El Conventional sewaOther l CL Size of tank: Septic Tank: 10D,> ri Z gallons Pump Tank: IDD,p, gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch o } feet ditches feet ditthoK k . k-
French Drain Required: linear feet
Authorized State Agent 0
Date