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HTE# j-- A S_ V6 7 if Harnett County Department of Public Health
PERMIT # ~3u Operation Permit 21822
New Installation VSeptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ~~1 car' ~CJ li SUBDIVISION LOT #
System Installer: C*J-i r J_7;t L/4 e, hcl Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms i
Type of Water Supply: ❑ Communi V-Public ❑ Well Distance from well feet
System Type: 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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6
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rtKFIII UAYUIIIUM:
1. 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 Ed'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are th
e specifications for the sew disposal system on the above captioned property.
Type of system:
❑ Conventional
Other Septic Tank: 10
gallons P mt>_Tank: gallons
Subsurface
No. of j
`
exact length r/ width of e
7
t w depth of
3
Drainage Field
ditches
of each ditch
feet ditches
feet ditches,,
inches
French Drain Required: Linear feet
Authorized State Agen TL1LJ1___ w ~ Date R- /I ( 4,10"1/