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Harnett County Department of Public Health
PERMIT # Operation Permit
New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 0
Name: (owner) . L. ecz o~ i, • <<, SUBDIVISION W y R LOT # 3
System Installer: , ova C t Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community )~k Public ❑ Well Distance from well 0 feet
System Type: 1-7 7~ k~ 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.
[his system has been installed m 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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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: V0"-'Q pyys~2r, Ste.Zi-r_ "~-o C G<-c1~C 4' CJN 7)13)o'a
Following are the specifications for the sewage disposal system on the above captioned pop rt.x o
Type of system: ❑ Conventional Other Pv e`S o Cr o ~,~gts~ t s 6 Qa g Septic Tank: ICJ gallons Pump Tank: ti000 gallons
Subsurface No. of exact length tib 9~ width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches tig inches
French Drain Required:
20523
Authorized State Agent Date
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