OPNTE# 0f -5-- Za - Harnett County Department of Public Health 2 0 91 6
PERMIT # -ZSS3/ 0 eration- Punt
New Installation 1 Septic Tank ❑ Repair E Nitrification Line ❑ Expansion
PROPERTY LOCATION:_ X I7s8 41,RAejVV 12,b
Name: (owner) Ac-6 & & C,_z SUBDIVISION LOT #
System Installer: c.>A~ Registration #
Basement with plumbing: El Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community C>1 Public ❑ Well Distance from well feet
System Type: ZSD, R*7) V C.T U1Q "514 ' >Y , Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must con a*,~partment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General s Rules for Sewage Treatment and Disposal, and ondn
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
111. Maintenance:
-M )-7g8 System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
of the Improvement Permit and Construction Authorization.
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IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z$vl- 96b0 73 7a,,j6k Septic Tank: /DOGS gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches Z of each ditch 20 o feet ditches feet ditches Z? • b rinches
French Drain Required: Linear feet
Authorized State Ag t~~l /y~,~,,1+~✓ Date Zl-l-/ )
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