OPHTE# 07-5 - /$Z99 Harnett County Department of Public Health 19857
PERMIT # ZYZZro peration PPerr it
New Installation {d Septic Tank O Repair Z"'Nitriliication Line 0 Expansion
PROPERTY LOCATION:
iysy, Name: (owner) AI A> &14=a=2 SUBDIVISION LOT #
System Installer. -C Jo -
Registration #
Basement with plumbing: ❑ Garage /umber of Bedrooms
Type of Water Supply: ❑ Community r public ❑ Well Distance from well feet
System Type: I i7Vr~// ~7d) S. svSt___ Types Y and YI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been inswied in compiance with aWicabk North Carohna General Statutes, W for Sew Treatment and and A conditions of the fmprmemmt Permit and fonsmKwn kdnrization
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
111. Maintenance: As required by Rule 1961. Other.
Subsurface system operator required? Yes ❑ No ❑
IY If yes, see attached sheet for additional operation conditions, maintenance and reporting.
. Operation;
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Size of tank: Septic Tank: 10 0 7)
Subsurface No. of gallons Pump Tank: gallons
exact length width of depth of
Drainage field ditches of each ditch d feet ditches
French Drain Required: feet ditches ) inches
near feet
Authorized State Agee- IN wz -r lLSS
Date _ 2 - Z S - Qy