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HTE# q Harnett County Department of Public Health 23475
PERMIT # a-2 g`7 Operation Pe
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 12� ell Zi
Name: (owner) _ SUBDIVISION S LOT #
System Installer: 5.� P Registration #
Basement with plumbing: ❑ Garage D mber Bedrooms 3
Type of Water Supply: El Community L Public ❑ Well Distance from well feet
System Type: / +-o 7` t • Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 6wner must contact Health Department 6 months prior to expiration for permit renewal.
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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 CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa isposal system on the above captioned property.
Type of system: El Convent Other Z'% Septic Tank: gallons Pump Tank: Zoo a gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3_ of each ditch 12,0 feet ditches _ feet ditches Zb inches
French Drain Required: Linear feet
Authorized State Agent / �-.�� Date 10—'1 --1'11