OPHTE# j &OZZ Harnett County Department of Public Health
PERMIT # Z&q Operation Pe~_ it 21 7 31
I/ New Installation I Septic Tank M/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S 1449 Zra;
Name: (owner) C g c',s/o-, L SUBDIVISION ~a 1 z5'-r LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ..5'-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 3~a tee f'1 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 I;arolina General Statutes, Rules for Sewage Treatment and tisposal, and all condi;ions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
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.
❑ D-Box ❑ Pump ❑ Alarm ❑ H120Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z5-01,p 111- Septic Tank: JZ _ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch J feet ditches 3 feet ditches 761 inches
French Drain Required: Linear feet
'Jo
Authorized State Date L- 2 y I i
(4a
r
c
`
v
.
T
y