OPHTE# y3 Harnett County Department of Public Health 21 0 8 0
PERMIT # N'4-30a- Operation Permit
"IN New Installation ~4 Septic Tank El Repair)X Nitrification Line 0 Expansion
PROPERTY LOCATION: "\yEt_. ~6 ~-A,
Name: (owner) -low Et_z_ G --J P,aQ-,> SUBDIVISION GATE-.,,EsN- LOT #
System Installer: CJ ~5 "S-rn.rc, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community N Public ❑ Well Distance from well 100 feet
System Type:Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his 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 Construction Authorization.
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1. 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 ❑ NoA
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other PL) \e 'So S--2-V ,-o\„r Septic Tank: s000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch to feet ditches 3 feet ditches inches
French Drain Reauired: r fav'f,-,,
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