OPHTE# %,�-Y- 3C)630 Harnett County Department of Public Health
PERMIT # 273o8 Operation Permit 22925
M'New Installation 12*"�eptic Tank P'litrification Line ❑ Repair ❑ Expansion
AA, PROPERTY LOCATION: O lc) O - VZ1
Name: (owner) �_1 o, ✓ ✓y AA, e1 SUBDIVISION ✓ e -A k- Xe- 1/445e LOT #
System Installer: cic1;1 zed :( — Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms /-/
Type of Water Supply: ❑ Community ['Public ❑ Well Distance from well feet
System Type: ZZZ 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.
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
I
3
e
✓
CI
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 ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sew9e disposal system on the above captioned property.
Type of system: ❑ Conventional Wr Other —Z—eLo ,> Septic Tank: a2( ,�� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a of each ditch / as feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent/�,. —_ /�%�� �. ; /1cF Date G /1Z I