OP RRHTE# og-s ZIZc$z,ZW Harnett County Department of Public Health 23614
PERMIT # Z 95-7'10 eration Per
New Installation Septic TankNitrification Line ❑ Repair Nr Expansion
PROPERTY LOCATION: �5t rsas®
Name: (owner) /ZZco�c n v SUBDIVISION LOT #
System Installer: K ar-� �Q �t,� o Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms S -
Type of Water Supply: ❑ Community (J Public Well Distance from well /6d' feet
System Type: Z5-% % �v Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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 -Bax ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z2A/Z&b-V t-a7� Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches �. of each ditch I Std feet ditches _
1-12O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches Z — y inches
French Drain Required: Linear feet
Authorized State Ag t Date I —Iq t S'�