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NTE# (6-S•3go_X Harnett County Department of Public Health 24299 PERMIT # grie"VN Operation Permit New Installation Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: R-9 Name: (owner) K,NG'S�`1 Za��L SUBDIVISION LOT # System Installer: Gvcz Av 4 Registration # Basement with plumbing: El V Number of Bedrooms 3 Type of Water Supply: ❑ CommunityPublic El Well Distance from well toCi feet System Type: � a Types V and VI Systems expire in S years. (In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal. IN 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:. Nousf= HI` O "y R I T C��Oev6RtP R9 PERMIT CONDITIONS I. Performance: System shall perform in accordance with Rule .1961. 11. Monitoring: As required by Rule .1961. 111. Maintenance: As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ N If yes, see attached sheet for additional operation cc IV. Operation: V. Other. maintenance and reporting. ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line Following are the specifications for the sewage disposal s stem on the above captioned property. Type of system: El Conventional X Other V Septic Tank: l©O 0 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field %itcl�"4-- of each ditch 5O feet ditches 3 feet ditches 4-aLl inches French Drain Reggie ' — Lincitr feet Authorized State Agent_ R41i5 Date