OPHTE# Harnett County Department of Public Health 24356
PERMIT # 28 / Operation Per it /
C91 New Installation Septic Tank C7�/Nitrification Line ❑ Repair ❑ �Z Expansion
�� /^ PROPERTY LOCATION14d CSA G Cs,,d.
Name: (owner) f�It�et'*! lD )nW'T�Z SUBDIVISION LOT # I
System Installer: ---ra Registration #
Basement with plumbing: ❑ Garage 6vumber of Be ooms z—
Type of Wate;Supply. Elommunity lad Public ❑ II Distance from well feet
System Type: Iyfwnl 2 7CT'z �s/W E Types V and VI Systems expire in S years.
(In accordancewit- h Tae V a) f /Owner must contact Health Department 6 months prior to expiration for permit renewal.
has been installed in corooliance with applicable North Carolina Ileneral Statutes, Rules for Sewage-'freanni and Disposal. and all conditions of the
PERMIT CONDITIONS:
I. Performance:
II. 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.
and
I -Jp I ta-9--L
,r4 s � is4t 23s
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Fallowing are the
specifications for the sew disposal sys m onq"the�abav captioned property.
Type of system:
El Conventional Other
6x> o---- Septic Tank l a c L
gallons Pump Tank —yt'zi-' gallons
Subsurface
No. of
exact length width of
depth of
I inches
Drainage field
ditches
of each ditch / !V feet ditches
feet ditches
French Drain Required: linear teett
Authorized State A / �/r�(�a�a,`L Date
-s:
ra+ r
16-5-38861 (1) 16-5-38861 (2) 16-5-38861 (3) 16-5-38861 (4) 16-5-38861(5)
16-5-38861 (6) 16-5-38861 (7) 16-5-38861 (8) 16-5-38861 (9) 16-5-38861 (10)
illOe ]R h
16-5-38861(11) 16-5.38861(12) 165-38861(13) 16-5-38861(14) 16-5-38861(15)
",*=ago
16-5-38861 (16)
16-5-38861 (21) 16-5-38861(22) 16-5-38861(23) 16-5-38861(24) 16-5-38861(25)
16-5-38861(26) 16-5-38861(27) 16.5-38861(28) 16-5-38861(29) 16-5-38861(30)
mom