OP RHTE# I`I Harnett County Department of Public Health 23578
PERMIT # 2 So9D�New
peration Pelt
❑ Installation E Septic Tank C' Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: ost-/606 a.ie- ,2.a
Name: (owner) ZJAIAe 1�f o,r,4�r,J SUBDIVISION LOT # Z_
System Installer: _r g&!t� _ Registration #
Basement with plumbing: ❑ Garage mber of Bedrooms
Type of Water Supply: ElCommunity VPublic ❑ Well Distance from well feet
System Type: "% 71,go 47 E !z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must ntact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 see disposal system on the above captioned property.
Type of system: ❑ Conventional 2 Other Z S°/b 1uDUYa� 5Ssfr--- Septic Tank: / aby 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 �_ inches
French Drain Required: Linear feet
Authorized State
Date
q-, 21 -15
14-5-34896R (1)
14-5-34896R (2)
14-5-34896R (3)
14-5-34896R (4)
14-5-34896R (5)
14-5-34896R (6)
14-5-34896R (7)
14-5-34896R (11) 14-5-34896R (12)
14-5-34896R (8)
14-5-34896R (9)
14-5-34896R (10)