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HTE# os --~ZjR,2 Harnett County Department of Public Health 2 1 2 7 g
PERMIT # S-L' T' 0 eration Permit
[/New Installation Septic Tank ❑ Repair Fr Nitrification Line ❑ Expansion
PROPERTY LOCATION: /11 Q Liek. CA-rtt X'i
Name: (owner) SUBDIVISION _ V
System Installer: Cif--~; LOT #
` ck/.^ 4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community V► Public ❑ Well Distance from well
System Type: 7--Ij - ~ feet
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(In y accordance with Table V a) Types V and VI Systems expire in 5 years.
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 Treatme t and Disposal, and all conditions of the
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
Permit and Construction Authorization.
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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 COY
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sew 8e disposal stem on the above captioned property.
Type of system: ❑ Conventional t Other & p { & Z Its
Subsurface No. of - Septic Tank: gallons Pump Tank:
exact length g p gallons
Drainage Field ditches width of depth of
of each ditch -7 ~ feet ditches ~
French Drain Required: Linear feet feet ditches Y'2 "L inches
Authorized State Agen 14J
Date 511116"o
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