OPHTE# Iq -s -33 f 5S7 Harnett County Department of Public Health 23586
PERMIT # Z-795— Operation Pe it
L2New Installation E- Septic Tank E� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONct14-31 &.t A,,Q i7,6
Name: (owner) z-4.T_.rtc— SUBDIVISION &a:j2,._-F LOT # �
System Installer: s Registration #
Basement with plumbing: ❑ Garage 2"'Number of Bedrooms 3
Type of Water Supply: ❑ Community [Z Public ❑ Well Distance from well feet
System Type: Z�lo rT1" G r:ZTypes 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.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 sewa disposal system on the above captioned property.
Type of system: El Conventional Other t-57% r twc yA,.,.. Septic Tank: Joe)n gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch fit' feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State AqQllf—V %71(A 57� Date — 1 11 1 `>
14-5-33185 (1) 14-5-33185 (2) 14-5-33185 (3) 14-5-33185 (4) 14-5-33185 (5)
14-5-33185 (6) 14-5-33185 (7) 14-5-33185 (8)