OP RHTE# Lz-S ' 19/GS'12 Harnett County Department of Public Health 19 8 6 8
PERMIT # Z444 2 /O~eration Permit
Z New Installation Septic Tank ❑ Repair 271 Nitrification line ❑ Expansion
(owner) ~ PROPERTY LOCATION:s~Li-7O-7 i2Ab
Name: //Zpntat ?.Jc SUBDIVISION -e~x3 LOT # L-
System Installer. I4SU/L 5631s_~ a Registration #
Basement with plumbing ❑ Garage Q*'Number of Bedrooms 3
Type of Water Supply: ❑ Community 0"Public ❑ Well Distance from well feet
System Type: o C,l Ly►J-5-4-S66- r4,,22, = 6 pes 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.
MIS s tem has been mstM in compliance with applicable North Carolina Genteral Statutes. Rides far Sewage Treatment and Disposal, and an conditions of the Ina owemetst Permit ad construction Audmniuook
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator requiredl Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional 7Ot*25 ~1Lt7VG~Size of tank: Septic Tank: Df U D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 5r t "e4
Drainage field ditches _ of each ditch g d feet ditches feet ditches 211-! Uhes
French Drain Required: _ Linear feet
Authorized State A
Date 3 - 7-D 8