OP RHTE# Harnett County Department of Public Health
PERMIT # �L,tl:10 _eratlo Permit 24292
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: OSIQI
Name: (owner) WEw.t �sz �O^ G Laaa SUBDIVISION Ifxic,gs M' ,,,,
System Installer: Oss, s S -t LOT # aL
a'�'`—'-�'�"� � Registration #
Basement with plumbing: ❑ Garage -. Number of Bedrooms
Type of Water Supply: ElCommuni .�] Public ❑ Well Distance from well 15S
System Type: feet
Types V and VI Systems expire in S years.
911
(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 an Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and
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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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals tem on the above captioned property.
Type of system: ❑ Conventional )4 Other Z t; c,
SubsurfaceNo. of Septic Tank: 10 CC gallons Pump Tank: gallons
exact length width of depth of
Drainage field of each ditch e100 feet ditches 3
French Drain Req uired:�xfeet feet ditches It inches
Authorized State Agent���� %�kc Date b��116
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1.
Al, -5-35o�a(L
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