OPHTE# y.zr�; _ Z&588'
PERMIT # Z "70 -�-
Name: (owner)
System Installer: Ae "mss
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type: e' AI
(In accordance with Table V a)
This system has been installed in compliance with
Harnett County Department of Public Health
/0 er_p ation Permit 22299
d New Installation C;7' Septic Tank Nitrification Line ❑ Repair ❑ Expansion
P P p
PROPERTY LOCATION: ( 9,n- r s rUZ
SUBDIVISION i�JN44-m& Pi- LOT #
Registration #
Number of Bedrooms Y
Public ❑ Well Distance from well
aL c.�... •7,TFc, 1 am n
Owner must contact Health Departm
North Carolina General Statutes, Rules for Sewage Treatment and Disposal,
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tems expire in 5 years.
6 months prior to expiration for permit renewal.
conditions of the Improvement Permit and Construction Authorization.
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 ❑
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 sewa a disposal system on the above captioned property.
Type of system: El Conventional IZOther 2-�& c.2ct1, Septic Tank: gallons Pump Tank; gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 15 of each ditch b feet ditches feet ditches inches
French Drain Reauired: Linear feet
j �--Y
Authorized State Ag _ t ,.,_Z % Date 1 " I — I Z