OPHTE# 4~-S-ZBO'I Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 3 2
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~RoWN
Name: (owner) Moss ~~or,Eau+L~f~~Z,S SUBDIVISION G"my& ,NEs LOT #
System Installer: L.omrr.E~_-Kiny1,45o,J Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community "K Public ❑ Well Distance from well la O feet
System Type: mac, 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
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
PWR Line
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E24- Septic Tank: ~,C)OO gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field s 1~ of each ditch CQZ feet ditches 3 feet ditches
French Drain Reauired: _ `z_ , inear feet
gallons
inches
Authorized State Agent Date Q