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HTE# 01- s- /fS-'lCt Harnett County Department of Public Health 19 613
PERMIT # )~y 1,3 Operation Permit
K New Installation P "'Septic Tank ❑ Repair El"'Nitri6cation Line ❑ Expansion
PROPERTY LOCATION: , IZ / q63
Name: (owner)S~t✓ btaclvlp'A'L~A SUBDIVISION Srz,, 14*4/, r'~ec.dC~sf LOT # _
System Installer. k-'30ak Registration # -/Q,')0
Basement with plumbing ❑ Garage evumber of Bedrooms
Type of Water Supply: ❑ Communi Public El Well Distance from well lee?
System Type: 71 Types V and VI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
IN s tem has been mstaed in can ante with Oicabk Not Carolina General Statutes, Auks for Sewage Treatment W Disposal, and aA conditions of the Improvement Pemiit and Conwucfion Audmira6oa
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PERMIT CONDITIONS: 47a iYC,
Performance: System shall perform in accordance with Rule .1961
Monitoring. As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 63"
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the s a disposal system on the above captioned property.
Type of system: ❑ Conventional ewOther ~Z 4-3 Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 8 Q feet ditches 3 feet ditches ~ " / t inches
French Drain Required: linear feet
Authorized State Agen Date 2 °°if