OPHTE# /S "S SrJS3 Harnett County Department of Public Health 23897
PERMIT # Z& 3 Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /7ZI Ti/rr1r.G>vJ
Name: (owner) INNA1rF 6o l SUBDIVISION LOT #
System Installer: ry LJeg"-s Registration #
Basement with plumbing: � Garaged❑ umber of Bedrooms
Type of Water Su ply: ❑ Community IZPublic ❑ Well Distance from well feet
System Type: �Vr.�.. t�T S%a .6%V�(,O-a.� &tr T,¢ /7 Types V and VI Systems expire in S years.
(In accordance with Tabl V a) Owner mus coni ct Health Department 6 months prior to expiration for permit renewal.
,�z ami
been installed in Compliance with apnlisable North Carolina General
I. Performance: System shall perform in accordance
If. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator requ et
If yes, see attached sheet for ad'
dit
IV. Operation:
V. Other:
.N/Z 1723
/K110
Rule .1961.
w t�
and all Conditions of the
Yes ❑ No ❑
lal operation conditions, maintenance and reporting
Permit and Conswction Authorization.
(C—,c-6s J --fir d� M,)%._
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewe disposal system on the above captioned property.
Type of system: 13 Conventional Other ZS% "'rir 11C rc%f1, Septic Tank: gallons Pump Tank / UO D gallons
Subsurface No. of exact length width of depth of
g /fir
Draina a Field ditches Z of each ditch / (o O feet ditches 3 feet ditches inches
trench Dram Required: linear feet
Authorized State A nt � Z��z Date Z—/4.—/(p
s
15-5-35753(l) 15-5-35753(2) 15-5-35753(3) 15-5-35753 (4) 15-5-35753 (5)
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I
i
l
15-5-35753 (6) 15-5-35753 (7) 15-5-35753(8) 15-5-35753(9) 15-5-35753 (10)
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R. f.
15-5-35753(11) 15-5-35753(12) 15-5-35753(13) 15-5-35753 (14) 15-5-35753(15)
15-5-35753(16) 16-5-35753(17) 15-5-35753 (18) 15-5-35753 (19) 15-5-35753 (20)
VIAi
r �
S
L\\ moi,
15-5-35753(21) 15-5-35753(22) 15-5-35753(23) 15-5-35753(24) 15-5-35753(25)
71
11 mz
�/, '• f 'R oaf ,jy ' A
15-5-35753 (26) 15-5-35753(27) 15-5-35753(28) 15-5-35753(29) 15-5-35753 (30)