OPHTE# d1-S_ 19830 Harnett County Department of Public Health 19865
PERMIT # 214 4 t 3 eration Per ~
New Installation 0 Se tic Tank ❑ Repair 0 Nitrifca
P tlon Ltne ❑ Expansion
PROPERTY LOCATION: se tsyz_ olL jus-A" cx"A- Itt>
Name: (owner) l'~A ljtc~/~EiLS (LC SUBDIVISION ~Se-e- 71r- LOT
System Installer. Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms -y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: FZE b fw v 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 instaW in compiance with applirab4e Borth cuobna General Statutes, lodes for lZW Tremnent and pisposA and all canditiom of the ImpraremeM Ptrmit and (onstnscton Aodrorintrors
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PERMIT CONDITIONS:
1. Performance:
II. 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 repotting.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other j5%R Ju Fri Size of tank: Septic Tank 10 oa gallons Pump Tank: gallons
Subsurface No, of exact length a width of depth of
Drainage field ditches of each ditch y~ feet ditches j feet ditches t8-216 inches
French Drain Required: linear feet
Authorized State
Date 3 - y - b'S