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Z3ek Harnett County Department of Public Health 20714
PERMIT # a~oZ' 4 ~ ~,.---0 erati0n Per~mi-t
L~ New Installation Id' Sept Septic Tank ❑ Repair lNitrifcation Line ❑ Expansion
PROPERTY LOCATION: die lL X,4.
Name: (owner) ~4.1-$ i-SUBDIVISION f, <f ►C~-,~,r LO
System Installer.. KQ,-.a V 160 Q-^ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ~t Public ❑ Well Distance from well feet
System Type: _777' /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.
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Imt system nas peen mstauea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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DCDMIT MIMITIAIIf.
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1. Performance
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 2'
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sew e dispos~ system on the above captioned prope l
Type of system: ❑ Conventional Other I rn It v (-v , c k CZ-- h- Septic Tank: ~ 13
gallons Pump Tank: l()00 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch I (J feet ditches feet ditches C infhuc
rent Drain Required: linear feet
Authorized State Agent
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and all conditions of the Improvement Permit and Construction Authorization.
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