OPHTE# I to –S –3S3d6 Harnett County Department of Public Health 24187
PERMIT # z9�%Operation Pe
IE/New Installation [x� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ivl 4-�Is lt4l*�
Name: (owner) f7z,441 e)' i ar SUBDIVISION .4-7'Zvs kLgze .eA. — LOT # L
System Installer: lams _ /1- -�F1 D Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 3
Type of Water Supp : ❑ Community Fpublic ❑ Well Distance from well feet
System Type: s4-$. tT*- F, Types V and VI Systems expire in 5 years.
(In accordance with Table V a) caner must-r#674act Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Farolina General Statutes, Jules for Sewage Treatment and Disposal, lassITTtilmlitioms of the Improvement Permit and (onstrurnon Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the,sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z.:5 '/T 1761 iV "-Z.I— Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch y 2 feet ditches - feet ditches 22— inches
French Drain Required: Linear feet
Authorized State A si�� gf L j�r� Date
16-5-38300 (1)
16-5-38300 (6)
16-5-38300 (2)
r
16-5-38300 (7)
16-5-38300(11) 16-5-38300(12)
16-5-38300 (3)
16-5-38300 (4)
16-5-38300 (8)
16-5-38300 (9)
16-5-38300 (5)
16-5-38300 (10)