OPHTE# JG -5--3-783'5— Harnett County Department of Public Health 24252
PERMIT# Z616-7-9—/ Operation Per 't
EY New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:ac../yr 61 A; -e.r_2D
Name: (owner) 64-4" �—j SUBDIVISION _/Z.a✓r� /GoPp LOT # L
System Installer: Registration #
Basement with plumbing: ❑ Garage 2�Number Bedrooms
Type of Water Supply: ❑ Community 2"Oublic ❑ Well Distance from well feet
System Type: Z`bsMtg��s..s,. -��.. C� %494!& d A � at V and VI Syste s expire in 5 years.
(In accordance with Table V a) Owner must contact Ith Department 6rmonths prior to expiration for permit renewal.
This system has been
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
with applicable North Carolina cynical Statutes, Rules rot
.`l
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
and
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
U'
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional C� OtherttM 1264 w Septic Tank: (100 gallons Pump Tank gallons
Subsurface No. of exact length! width of depth of
Drainage Field ditches of each ditch feet ditches ?J' feet ditches L2- inches
French Drain Required: Linear feet
Authorized State Agent �� C� yV (fs , r� �j]%� " Date
16-5-37835 (1)
16-5-37835 (2)
16-5-37835 (3)
16-5-37835 (4)
16-5-37835 (5)
16-5-37835 (6)
16-5-37835 (7)
16-5-37835 (8)
16-5-37835 (9)
16-5-37835 (11)
16-5-37835 (12)
16-5-37835 (13)
16-5-37835 (14)
16-5-37835 (10)