OP'ATE# Harnett County Department of Public Health I
2348
PERMIT # Z 13 (-5 Operation Permit
D' New Installation 121'Septic Tank E?Iltrifcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:A_Iyy� e4o-�.jb cive r4j)
Name: (owner) 2 SUBDIVISION LOT # Z-1
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community O'-Public ❑ Well Distance from well feet
System Type: LSA 17 pe, G GL Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must ontact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
with applicable North Carolina General )tatutes, Nules for )ewage Ireatment and
and an conditions or me improvemenr rerm¢ and ionsiruaion xumunzarmn.
cv"k- c�-r-
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 sewaye disposal system on the above captioned property.
Type of system: ❑ Conventional Other /? Septic Tank: l D gallons Pump Tank: _ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch a D feet ditches 3 feet ditches IS—TS inches
French Drain Required: Linear feet
Authorized State Date
13 -5 -30895 (2)
13 -5 -30895 (3)
13 -5 -30895 (4)
13 -5 -30895 (5)
13 -5 -30895 (6)
13 -5 -30895 (7)
13 -5 -30895 (8)
13 -5 -30895 (9)
13 -5 -30895 (10)
13 -5 -30895 (12)
13 -5 -30895 (13)
13 -5 -30895 (14)
13 -5 -30895 (1)
13 -5- 30895(11)