OP RHTE# /L- — 30311rZ Harnett County Department of Public Health
PERMIT # Z7ZL/61 Operation Pier It 22660
I2'� New Installation Septic Tank 127 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION• . /V `/
Name: (owner) - ,4�C SUBDIVISION 1t' OT #
System Installer: t ;'s1,r. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms .5
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from we feet
System Type: 2r JZGW ryple V and VI Systems expire in 5 years.
(In accordance with Ta le V a) 'I� st contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed In compliance with applicable North larolma heneral Statutes, Rules for Sewage treatment and
and all conditions of me Improvement rermlt and LOOstructlon Authorization.
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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR line
Following are the specifications for the sewage disposal system on the above captioned pro err
Type of system:
El Other ZAP,,) 7' LZ-42 � Septic Tank: % �° gallons Pump Tank: / � gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch / feet ditches feet ditches % i inches
French Drain Required: Linear feet
Authorized State n /v t ` Date '» _