OPHTE# 0 9-S-J0- ~ Harnett County Department of Public Health 2 0 6 2 6
PERMIT # 0 eration Per
New Installation Septic Tank ❑ Repairl Nitrification Line ❑ Expansion
PROPERTY LO \
Name: (owner) 01,A M 6 /hW ~IJm e 5' SUBDIVISION ~YN C
LOT #
System Installer: t 2OW n Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -12
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: Q..., _t 1, `-E (ys'- S/' Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nw ~piem nai ueen msiauea in compnance wins appucatne nortn Laronna beneral statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS: ~C
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
+ra~cui anon Fa Bonn m aLwIuaute mla nWe .1701.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No1~1,,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other ( ~L x (I Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _ feet ditches feet ditches inches
French Drain Required: Linear feet
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