OP RRHTE# 15-5-3 nlg6� Harnett County Department of Public Health 24016
PERMIT #a -Y7 5'7 Operation Permit
)Fl New Installation V Septic TankNitrification Line ElRepair El Expansion
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PROPERTY LOCATION: cs n
Name: (owner) V� SUBDIVISION LOT #92N,
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community �, Public ❑ Well Distance from well 16' feet
System Type: i3S xa Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Inis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (contraction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other.
maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are
the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
X Other E Z Va ew
Septic Tank: 10 0 o gallons Pump Tank: gallons
Subsurface
No. ofexact
length
'7ra'
width of depth of '/
Drainage I
ditches 3 of each ditch feet
ditches 3 feet ditches � -34 inches
French Drain
Required:
Linear feet
Authorized State Agent � Date bJ '-1114
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