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HTE# lyra -S-_40 cvfL Harnett County Department of Public Health 24600
PERMIT # Operation Permit
New Installation �S Septic Tank >( Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0o.-4ev,06CG
Name: (owner) Lwr+c.r5TC3� t NaNcy a Mt kC SUBDIVISION)LOT #
System Installer: Registration #
Basement with plumbing:X Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims sysmin Das oeen inssaum in mmpuanm wan appncmie morin urouna uenerm >mui nines Tor xwage sreasment ma msposai, ana an mnumom os me impmwmem rerma ana sonsnrnon nuumnaanon.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
IL 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 ❑ _
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other --' F's- ^`^+ Septic Tank
Subsurface No. of exact length width of
Drainage Field —Aitch of each ditch 1 S feet ditches _
french Drain Reauiredea, Linear feet
H2OLine ❑
PWR Line
►6b gallons Pump Tank gallons
depth of
3 feet ditches t9' ani inches
bEiLD'N Pte'• CaPPE
Authorized State Agent 'ice\\ ' � \ �-&�5 Date
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