OPHTE# I's —S ' 3?3 Z3 Harnett County Department of Public Health 24030
PERMIT # Z66-85 / Operation Permit 1
Q New 'Installation SepticTank LI Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATION: TAJ7ai - D 2JJ
Name: (owner) Z, . C SUBDIVISION -T-1 2 LOT #
System Installer: dr - E.r�°.--- Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms 3
Type of Water Supply: ❑ Community lv Public ❑ Well Distance from well feet
System Type: La-"Z PA-Oyice .` s js k, r ,, tc c �ypes V and VI Systems expire in S 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 mmmliana with aomliable North Carolina General Statutes. Rules
Ls'o.
and Dimosal. and all conditions of she
1s
J
36
Permit and Construction Authorization.
P4.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961. 5ti17,b5 W -S c/,- 40 b
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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 13. Other 75'1, t2-"�YO tri Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z'— of each ditch /W feet ditches feet ditches 1 inches
French Drain Required: Linear feet
Authorized State Z 111�/dnZ1142K2 Date
15-5-37323 (1) 15-5-37323 (2) 15-5-37323 (3) 15-5-37323 (4) 15-5-37323(5)