OP RRNTE# RsZ Harnett County Department of Public Health 24218
PERMIT # 781A(e / 0 eration Pe It
d New Installation Rf Septic Tank E/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION
Name: (owner) Z)gnfied( 4,0' SUBDIVISION 5%E 17z� LOT # F
System Installer: rN.Pi;f. Registration #
Basement with plumbing: ❑ Garage mber of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: / C F ZTypes V and VI Systems expire in S years.
(In accordance with Table V a) Owner must can t Health Department 6 months prior to expiration for permit renewal.
This system has been instilled in compliance with applicable North
Treatment and Disposal. and all conditions of the
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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.
Authorization.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
following are the
specifications for
the sew a disposal s tym on the above captioned property.
sew
Z i2K
Type of system:
ElConventional
` o b1(t,d'�/
Septic Tank: I to& gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
3
Drainage Field
ditches
t of each ditch 36 G feet
ditches feet ditches 7241 P, inches
French Drain Required: Linearfeet
Authorized State Ag t G Date 01 J �+
mo��z: -t
14-5-34071 R (1) 14-5-34071 R (2) 14-5-34071 R (3) 14-5-34071 R (4) 14-5-34071 R (5)
y
14-5-34071R (6) 14-5-34071R (7) 14-5-34071R (8) 14-5-34071R (9) 14-5-34071R (10)
i t
14-5-34071R(11) 14-5-34071R(12) 14-5-34071R(13) 14-5-34071R(14) 14-5-34071R(15)
Aak
on
1p
11 w