OPHTE# jZ-f�? Z
PERMIT # ZS71�1
Name: (owner) ,/ / Ozgt
System Installer. .de.. -A
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type: zf
(In accordance with Table V a)
This system has been installed in comolianre with
I. Performance:
II. Monitoring:
III. Maintenance:
IV, Operation:
V. Other.
Harnett County Department of Public Health 24515
/Operation r j
New Installation W Septic Tank Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION-'W"�?,62rZemvZis peO
alp SUBDIVISION x�c I I��GCs�a�LOT # �3
%ate? Registration #
umber of Bedrooms q
�blic ❑ Well Distance from well feet
Types V and VI Systems expire in S years.
Ownerct Health Department 6 months prior to expiration for permit renewal.
Rules for Sewage Treatment and Disposal, and all conditions of the
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewagC disposal system on the abov captioned property.
Type of system: El Conventional C�' Other 00' / �!Sor Septic Tank: I?b gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches �_ of each ditch c—X—:.> feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Ag �% ���-r Date %' 7
NOUN
17-5-40972 (1) 17-5-40972 (2) 17-5-40972 (3) 17-5-40972 (4) 17-5-40972 (5)
V
17-5-40972 (6) 17-5-40972 (7) 17-5-40972 (8) 17-5-40972 (9) 17-5-40972 (10)
W +! F
17-5-40972 (11) 17-5-40972 (12) 17-5-40972 (13) 17-5-40972 (14) 17-540972 (15)
17-5-40972 (16) 17-5-40972 (17) 17-5-40972 (18) 17-5-40972 (19)