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HTE# 08-S-- lg5Z6 Harnett County Department of Public Health 2 0 8 9 4
PERMIT # zgLj' , Operation Permit
1 New Installation [I Septic Tank ❑ Repair i Nitrification Line ❑ Expansion
PROPERTY LOCATION: _x_t 70
Name: (owner) SUBDIVISION LOT
System Installer: N..~tt Oeek, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: 11 Community Public ❑ Well Distance from well feet
System Type: 2S ?,4b#4to,... ; 2r6- "L3_T 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.
Ims system nas peen mscaneo in 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 4111111 1.V11 VII IV11l.
I. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
Following are the specifications for the sews disposal system on the above captioned property
Type of system: ❑ Conventional Other ?S'/o ik60CXlc-
Septic Tank: _/obn gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /vo feet ditches f f
feet ditches inches
French Drain Required: Linear feet
Authorized State Ag Date I I - w - pj
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