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Harnett County Department of Public Health 21 3 0 8
PERMIT # oT S 8 Operation Permit
❑ New Installation ❑ Septic Tank V Repair E?r Nitrification Line ❑ Expansion
PROPERTY LOCATION:
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Name: (owner) j c.rti~~~ ~z ll SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community CeKPublic ❑ Well Distance from well feet
System Type: 7 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.
nns system nas teen mstanet in comps ance witn appucahle North larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
Permit and Construction Authorization.
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1. Performance:
II. Monitoring
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No e'
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the ssppecific i ns for the sewage disposal system on the above captioned property.
Type of system: 2 Conventional V Other i ;rte C~, p~~ Septic Tank:Y°l~ c gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S"c3 feet ditches feet ditches inches
trench Drain Required: Linear feet
Authorized State Agent Date
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