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HTE# j) - yc_Z39064eel Harnett County Department of Public Health
PERMIT #p~ eration Per 1 21 7 3 7
New In
stallation Tank
Septic Nitrffi
L'f cation Line ❑ Repair ❑
Expansion
PROPERTY LOCATION: jgD-i
Name: (owner) Aqy 1 - d> SUBDIVISION LOT #
System Installer: ,14V
Registration #
Basement with plumbing: ❑ Garage Q ber of Bedrooms 3
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
System Type: 2-35% 4006514-s-A 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 neral Statutes, Rules for Sewage Treatment and Disposal, and all coi
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Est'
1
PERMIT CONDITIONS: i q a
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
of the Improvement Permit and Construction Authorization
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional 1Zf OtherZ Septic Tank: /OOZ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch b feet ditches feet ditches 21 inches
French Drain Required: Linear feet
Authorized State Ag t Date
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