OPHTE# 13- s= 31948 Harnett County Department of Public Health
PERMIT # Z751-8 Operation Permit 22997
Name: (owner) C f /�p� sic
System Installer: 65 --
Basement with plumbing: ❑ Garage 2 umber of Bedroom
Type of Water Supply:
El L%i Public ❑ Well
System Type: t Fro Ls L4 -",-- 1754� -�
(In accordance with table V a)
2""New Installation C2'�'Septic Tank CNitrification Line D Repair D Expansion
PROPERTY LOCATION:3?t-..a415' /(,wLs
SUBDIVISION SiF:s6-0 LOT #
Registration #
3
Distance from well feet
3 - icon Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Ireatment and
PtKMII CUNUIIIUNS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
and an conditions of the Improvement Term¢ and Lonstrucnon numorrzatmn.
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 ❑
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other htq. d„ Septic Tank: ) °D
Subsurface No. of exact length OD of
Drainage Field ditches of each ditch °a feet ditches
French Drain Reauired: linear feet
H2O1-ine ❑ PWR Line
gallons Pump Tank: 0 gallons
depth of
feet ditches ZN inches
Authorized State nt _ \ Date 10 "30 - l
13 -5 -31948 (1)
13 -5 -31948 (2)
13 -5 -31948 (3)
13 -5 -31948 (4)
13 -5 -31948 (5)
13 -5 -31948 (6)
13 -5 -31948 (7)
13 -5 -31948 (8)
13 -5 -31948 (9)
13 -5 -31948 (11)
13 -5 -31948 (12)
13 -5 -31948 (13)
13 -5 -31948 (14)
13 -5 -31948 (10)