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HTE# Z JIZ Harnett County Department of Public Health 3 211
PERMIT # Operation Per t
2--'New Installation /Nitrification Line ❑ Repair ®' Expansion
PROPERTY LOCATION: _ .I
Name: (owner) SUBDIVISION LOT #_
System Installer: Zj ` r' - Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms`
Type of Water Supply: El Community 2r Public ❑ Well Distance from well feet
System Type: a ,. I-r,- —12,02,c— /4 p V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Ith Department 6 months prior to expiration for permit renewal.
This system has been installed in
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with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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PERMIT CONDIT"es�all
I. Performaaccordance with Rule .1961.
II. Mo nitori _
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage-disposal ew system on the above captioned property.
Type of system: El Conventional Lt Other 1,tlg. U _ Septic Tank: Ilons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch feet ditches_ feet ditches 756 inches
French Drain Required: Linear feet
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