OPHTE# I'�- .--ssZ-)y Harnett County Department of Public Health 24183
PERMIT# 288 z3 Operation -- Permit �/
Ld New Installation Ca3 Septic Tank Ld Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: e-: Oaf nt
Name: (owner) /%TiaAy'/ da2&5r SUBDIVISION t(l LOT # 47-
System
zSystem Installer. v Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3—
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type:ZSR TIr G rLc a.. Types V and A Systems expire in S years.
(In accordance with Table V a) a UOwner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statuses, Rules for Sewage Treatment and Disposal, and all cunditiam of the Improvement Permit and Construction Authorization.
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DLYMIT rnNn1T1na6 /
1. Performance:
11. 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 reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa,8e disposal ss1stem on the above captioned property.
Type of system: ElConventional I❑ Other Zs /I 3LQf� ta+t . , Septic Tank: /0' " gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch I �� feet ditches `� feet ditches If— Z6* inches
French Drain Required: Linear feet
Authorized State nDate ' ct - ( 4
16-5-38274 (1)
16-5-38274 (2)
16-5-38274 (3)
16-5-38274 (4)
16-5-38274 (5)
16-5-38274 (6)
16-5-38274 (7)
16-5-38274 (8)
16-5-38274 (9)
16-5-38274 (11) 16-5-38274 (12) 16-5-38274 (13)
16-5-38274 (14)
16-5-38274 (10)