OPHTE# 14-s 1�o1Z Harnett County Department of Public Health 24257
PERMIT # Zj'� 3 / 0 eration Per It
d New Installation Septic Tank Nitrification line ❑ Repair ❑ Expansion
�� PROPERTY LOCATION-. �� 'Q _ _ �
� C.
Name: (owner) �sA , SUBDIVISION LOT # Ski
System Installer. .2�� Registration #
Basement with plumbing: ❑ Garage ��° tuber of Bedrooms —3
Type of Water Supply: ❑Community hd" Public ❑ Well Distance from well feet
System Type: ZV — S:.wS_ 274 o !7 6 d, V and VI Systems expire in S years.
(In accordance with Table V a) % Owner�rtrart.tlealth Department 6 months prior to expiration for permit renewal
This system has been installed in compliance with applicable North Carolina General Statuses. Rules for Sewag Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. Performance:
If. Monitoring:
111. 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 ❑
F120Line ❑
PWR Line
Following are the specifications for the sewage disposal s stem on the above ca tinned property.
Type of system: ❑ (onventional ❑ Other 25 RauPs...Z>_ Septic Tank: 1 vo 6 gallons Pump Tank: gallons
Subsurface No. of exact width of depth of
Drainage Field ditches �_ of each ditch �2 �� feet ditches -3 feet ditches )8 inches
French Drain Required: Linear feet
Authorized State 4ent Date I { - Z Ise
16-5-39042 (1)
16-5-39042 (2)
16-5-39042 (3)
16-5-39042 (6)
16-5-39042 (8)
16-5-39042 (4)
4
16-5-39042 (9)
16-5-39042 (5)
16-5-39042 (10)