OP RRHTE# = x-' Harnett County Department of Public Health
PERMIT # Z(~ 57 ,Operation Pe °nit f 21 7 4 6
9 "New Installation Septic Tank I?~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:
Name: (owner) ~TZ7 SUBDIVISION LOT # 1-~a-
System Installer: J41 GtZM.~ Registration #
Basement with plumbing: ❑ Garage IZ ;Number of Bedrooms .3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: t~.C Y) * t>~- Ay-~ C Zi4tres 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.
ll. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property
. rte
71 Type of system: ❑ Conventional Ia Other s ' A e'--JD ' STank: sr gallons Pump Tank: gallons
Subsurface No. of exact len th width of depth of
Drainage Field ditches 2 of each ditch , feet ditches feet ditches . _~"I inches
French Drain Required: Linear feet
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