OPHTE# 07 -s-- /994 6 Harnett County Department of Public Health 19864
PERMIT # Zyy 76 ~0 e-r-ation Permi
Ned ew Installation Septic Tank O Repair 0' Nitrification Line 0 Expansion
PROPERTY LOCATION:/7Q7 ,cJ~i~Qnt~S ya
Name: (owner) l3.yrr • - /*y>,,~s 2~G SUBDIVISION LOT # /S-
System Installer. g.z S~a~ Registration #
Basement with plumbing: El Garage ber of Bedrooms 3
Type of Water Supply: El Community _ Public ❑ Well Distance from well feet
System Type: L~/o rZEDUU'Z~J~s~l~,..7~ G ,Et t.~c~ -Types Y 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.
This system has been irsstM in compliance with applicable North Carolina General statutes, M I Sewage Treatment and Disposal, awl aN condtiom of the hnprorement Pettsut and (omnction Aodwrizatron.
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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.
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Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~S Size of tank: Septic Tank: 10 0 D gallons Pump Tank: allons
Subsurface No. of 7exact le gth g
width of depth of
Drainage field ditches h ditc h 8& feet ditches 1q . 73 French Drain Required: feet ditches - 4 ~ inches
linear feet
7i 7y- 7nl
Authorized State A t Date 3-7-66