OPHTE# o-7- 5-- / 8gl5 Harnett County Department of Public Health 19844
PERMIT # ?yam u 0 eration-Pere it
O /New Installation Q Septic Tank D Repair D" Nitrification line ❑ Expansion
PROPERTY LO(ATION:,W z6o2.
Name: (owner) Cyr B,c~ ~rta~,~ SUBDIVISION LOT #
System Installer. Tt,s Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms -
Type of Water Supply: ❑ Community Q' Public ❑ Well Distance from well feet
System Type: R r,y 7Z G Z Types Y and A Systems expire in 5 years.
(In accordance with Table Y a)
Owner must contact Health Department 6 months prior to expiration for permit renewal.
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North Carolina General Statutes, Auks for Sewage Treatment and Disposal, and aji conditions of the
Permit and Construction Authorization.
FO 1137a-~ E
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PERMIT CONDITIONS:
S IL ISO 2,
I. Performance: System shag 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:
Y. Other.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other j.5°-/n11bp(? Size of tank: Septic Tank: food gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch t2 a feet ditches feet ditches - inches
French Drain Required. Linear feet
Authorized State Age Date - Z L4 -OR