OPH T E # X0-5- Z3S29 Harnett County Department of Public Health 21 0 61
PERMIT # Zf7Z3 / Operation Pe it
Eil New Installation FvY Septic Tank ❑ Reaair /Witrification Line ❑ Expansion
r PROPERTY LOCATION: &x-/`/t8 04-F,'.,2, ~Q,, &6
Name: (owner) .57 IJfFrt~ W /faza SUBDIVISION Wfi/A0A.,x~ LOT # z4
System Installer: 14&-tcfe- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: 61Ax~~ It Zs°l F640604,0 Z iJTV75 GZ~i~pes V and VI Systems expire in 5 years.
(In accordance with Table V a) (r+ klno) 16wner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applidable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
1. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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Permit and Construction Authorization.
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System shall perform in accordance with Rule .1961. stitylg d*k-or&~' Zw&'c-at)
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.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other 11% tz&-,c)om r ~l►1b4,; k~ Septic Tank: gallons Pump Tank: 1 e~ gallons
Subsurface No. of exact length width of depth of r
Drainage Field ditches of each ditch f ? y feet ditches 3 feet ditches Zg inches
French Drain Required: Linear feet
Authorized State Ag Date: