OPNTE# l5 5-3 )2 Harnett County Department of Public Health 24278
PERMIT # Zn010 Operation Permit
i{ New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: lQq KN PL\N 6 R9
Name: (owner) Pit } G Ww�CCJQ)\fiL `a�s�r�OtJ SUBDIVISION LOT # 49,
System Installer:=v" SOC-0Cy Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community �'4 Public ❑ Well Distance from well rJ O feet
System Type: =337 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.
This system has been installed in rompliance with applicable North Carolina General statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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PERMIT CONDITIONS
I. Performance:
11. 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,)K
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D•Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E.Z 4a_a,�y Septic Tank: t oO d gallons Pump Tank:
Subsurface No. of exact. length width of depth of
Drainage Field �dtcJs l of each ditch 3Z(5 feet ditches --Nfeet ditches 11-3a
French Drain Reouired: \ linear feet
Authorized State Agent Date
PWR Line
gallons
inches
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