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Harnett County Department of
Public Health
PERMIT # ZGW-
Operation PPerit
G2' New Installation 2" Septic Tank L>~ Nitrification Line ❑
2 2 2 7 8
Reaair ❑ Exnansion
PROPERTY LOCATION-_c,
Name: (owner)gg!g s SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage U, umber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well fet
System Type: 1 a yp a VI'Sy`s ems expire in 5 years.
(In accordance with Table V a) Owner must contact Health epartment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules fo4e Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance wit le .1961.
11. 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, tenance an reporting.
IV. Operation:
V. Other:
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❑ 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 Other 75-% Septic Tank: I ZDO gallons Pump Tank: gallons
Subsurface No. of t' exact length width of depth of
Drainage Field ditches `i of each ditch feet ditches feet ditches 0.0 inches
French Drain Required: Linear feet
Authorized State A¢ettt t 1 1 Date is "Z-1- / 7-
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11-5-27983 (1) 11-5-27983 (2) 11-5-27983 (3) 11-5-27983 (4) 11-5-27983 (5)
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11-5-27983 (11) 11-5-27983 (12) 11-5-27983 (13)