OPHTE# /a- ,s- -Zs�.'lob Harnett County Department of Public Health
PERMIT # a. -2 / 12- Operation Permit 22391
C"New Installation peptic Tank �Nitri6cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: mew- _
Name: (owner) ��-� �c t' 6u`< d��s SUBDIVISION r n , 4 LOT # `` q
System Installer: S4-y— .^.c: 3,;: t A -t,-/ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community (Public ❑ Well Distance from well feet
System Type: ZE G- 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.
Ihis system has been installed in compliance with applicable North Larolma beneral Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 sew a disposal system pin the above captioned property.
Type of system: 11 Conventional sew
EZF/o=Aj Septic Tank: !Cx-1° gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch -5-0 feet ditches feet ditches J'�` 2 inches
French Drain Required: Linear feet
Authorized State Agen w� - ��'�� Date Cd //'14--/Q1