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HTE#16-5-39yA Harnett Count De artment of Public Health
PERMIT # Operation Permit
New Installation '�K Septic Tank 115 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: P%oM,*icXAC A
Name: (owner) Esr,c-Qr> lL_l Qc-F. s,4 -z:g� SUBDIVISION `YNsnsSA 'baa s LOT # -I—
System
System Installer. _w t LP. Co -,S "<r% at.l Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Commi ni"ublic ElWell Distance from well feet
System Type: Types V and YI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ims system has been Installed to <omphance 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation cr
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other EZ F._ct v Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface N exact length width of depth of
Drainage Field ditches of each ditch 133 feet ditches 3 feet ditches 1�i inches
French Drain Reauired:_ r feet
Authorized State Agent Date 5