OPHTE# 2jq$L Harnett County Department of Public Health
PERMIT # Z-7CZ3 Operation Pe It 22466
New Installation SeDtic Tank /Witrification Line ❑ Reaair ❑ Exnansior
n �^- PROPERTY LOCATION :c QWC, ti tp b . fiE ,
Name: (owner) X l" o SUBDIVISION CAY4 LOT # 2—
System Installer: Registration #
Basement with plumbing: ❑ Garage �/�umber of Bedrooms 3
Type of Water Supply: El Community Ld Public ❑ Well Distance from well feet
System Type: ZSV
c t i—. %` Cg 49-7 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ,Owner must contact Health Department 6 months prior to expiration for permit renewal.
rtKMII WNUIIIUM:
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 ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the s a disposal system on the above captioned property.
Type of system: El entional ewa Conv Other Zi6 _ Septic Tank: /COO— 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
Authorized State ent Date %G ° Z -1 `a.-
12 -5- 29486(2)
12 -5 -29486 (3)
12 -5 -29486 (4)
12 -5 -29486 (5) 12 -5 -29486 (6)
12 -5 -29486 (7)
12 -5 -29486 (8)
12 -5 -29486 (9)
12 -5 -29486 (1)