OP RHTE# i -!-' 54YU1 Harnett County Department of Public Health 23212
PERMIT # Z-77-3 12- erp ation Per
E2 New Installation Tank ZNit
cati_ o n Line El ✓ R e air ❑ Expansion
PROPERTY LOCATION: 2'
Name: (owner) .�v SUBDIVISION LOT #
System Installer: ,lei � Registration #
Basement with plumbing: ❑ Garage tuber of Bedrooms
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: � 1 <. r L?�' 6 60 � es V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta ealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
Q
t
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Permit and Construction Authorization.
1_11 I
In
—.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the s disposal system on the above captioned property.
entional ewa
Type of system: ❑ Conv Other Z f 5* 471— Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches 14 —'111S inches
French Drain Required: Linear feet
Authorized State Age t Date �" i
14- 5- 32819R (13)
14- 5- 32819R (12)
14- 5- 32819R (11)
14- 5- 32819R (10)
14- 5- 32819R (9)
14- 5- 32819R (8)
14- 5- 32819R (7)
14- 5- 32819R (6)
14- 5- 32819R (3) 14- 5- 32819R (2) 14- 5- 32819R (1)
14- 5- 32819R (5)
14- 5- 32819R (4)