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NTE# Harnett County Department of Public Health 24951
PERMIT # 0 eration Per 'tom
❑ New Installation Septic Tank ❑ Nitrification line L'1 Repair 11 Expansion
PROPERTY LOCATION:_ all LVL Coiroe <1 LP ni.i �r t z4 i5 2 I�
Name: (owner) VMe -ck SUBDIVISION L` W co, n� to V LOT #
System Installer: a� Aka Registration # 5 ,L I yt,
Basement with plumbing. ❑ Garage ❑er of Bedrooms
Type of Water Supply: ElCommunity p Public ❑ Well Distance it well feet
System Type: V xi 1"L i A r.i ry S , 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.
finis system has been installed in compliance with applicable North Carolina General statures, Rules for Sena a Treatment and Disposal, and all conditions of the Improvement Pemdt and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 67,*�
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm
Following are the specifiatyioos-ff�� the sewage disposal system on the above captioned property.
Type of system: onventional ❑ Other
Subsurface No. of exact length f>ePrWX 4SCt
Drainage Field ditches 3 of each ditches feet
❑ H2OLine ❑
PWR Line
Septic Tank:_ gallons Pump Tank: gallons
width of depth of
ditches .12, bot ditrhn<
trench Drain Required: lnear feet ...... ' """"
Authorized State Agent Date 3 �, 1 �bt$
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