OPHTE# yHarnett County Department of Public Health 23774
PERMIT # 26ZId Operation Pe It �/
E,3'/New Installation c Tank IJ Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION 1N37
Name: (owner) -574A� Q / S _, SUBDIVISION LOT # "7
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms —S
Type of Water Supply: ❑ Community 0" Public ❑ Well Distance from well feet
System Type: Z i ✓ l G 0Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must c2Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
If. 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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sdisposal system on the above captioned property.
Type of system: [Iewa Conventional Other ?. 0&� UCS� Septic Tank: / y CD 0 gallons Pump Tank: gallons
Subsurface No. of exact length a width of depth of
Drainage Field ditches of each ditch d feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State A26n't_ "--Z— /X/4 - Date e " 3 — 15 -
PERMIT
s
15-5-35524 (1)
15-5-35524 (2)
15-5-35524 (3)
15-5-35524 (4) 15-5-35524 (5)
15-5-35524 (6)
15-5-35524 (7)
15-5-35524 (8)
15-5-35524 (9)