OP RRHTE# Q9-50o- 17s72 t'?-< Harnett County Department of Public Health 2 a 9 2 7
PERMIT # a SSA Operation Permit
C New Installation [Septic Tank El Rer~ Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~ ~ fo
Name: (owner) A- SUBDIVISION c LOT #
System Installer: C'. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _
Type of Water Supply: ❑ Community( Public ❑ Well Distance from well feet
System Type: (-n < C hS G 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
IF\
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PERMIT CONDITIONS:
I. 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-J9
If yes, see attached sheet for additional operatio
IV. Operation:
V. Other
maintenance and reporting.
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~Z Other vt CL, P 5 Septic Tank: gallons Pump Tank allons
Subsurface No. of exact length width of g
Drainage Field ditches depth of
of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age
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Date 9=a L_
Permit and Construction Authorization.
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Driver: t~ stern
Libby
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11tf f^:7! 00 firs chips is from the Fuel Grade location and meets the Na specltlcaN4a ce.-- > f j,
voted In tnhova- ive Wastewater system approval JW~#3-204--03R for Ifii
S"Oution tar Rack Agpreprg% in NBrif Callon Fie{ .
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