OP see folder Carolina Lakes DentistryHTE# a'i- 5- 22; Harnett County Department of Public Health 21384
PERMIT # 25 9 (ek Operation Permit
9 New Installation f? Septic Tank ❑ Repair EA Nitrification Line ❑ Expansion
PROPERTY LOCATION:- ftw-C 91 / HL-, y, -x `t
Name: (owner) Art ~r--~ er-~.~ s SUBDIVISION o y, ' LOT #
System Installer: Dra.,-f~~sSw.~~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 53 S E'} D-r' 4;X a,Fr.c~
Type of Water Su ply: ❑ Community K Public ❑ Well Distance from well loo feet
System Type: ~C=.Rvt` 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.
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 fnNnITIt1fJC• ~
I. Performance:
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961. N C 87 ~N a114
As required by Rule .1961.
As required by Rule .1961. Other
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IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ` Conventional ❑ Other "W 4 Septic Tank: (a S~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches '3 feet ditchrc
French Drain Required:-
Linear feet
Authorized State Agen Of .
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