OP RHTE#O1`F-~~,-1`Jt}9-... Harnett County Department of Public Health 21 4 5 6
PERMIT # 0 eration Permit
New Installation Septic Tank 0 Repair X Nitrification Line O Expansion
PROPERTY LOCATION:
Name: (owner) VII o,,4 g-tr ~o\.r Nas>S SUBDIVISION GATE,.,.,tL~j~ LOT #
System Installer. L-o G~So VIA N so Registration #
Basement with plumbing: ❑ Garage ;N-\ Number of Bedrooms
Type of Water Supply: ❑ Community .-"K, Public ❑ Well Distance from well k n O feet
System Type: 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.
This system has been installed in compliance with appii(aWe North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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#^I r4 r.110. PERMIT CONDITIONS: n
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other. Ez Vr i--z v r Septic Tank: l 0p d
gallons Pump Tank: Subsurface No. of gallons
exact length width of depth of
Drainage field ditches of each ditch a 00 feet ditches
\ feet ditches 4
French Drain Reauirerk~n 11~11' inches
Authorized State Agent a-C-r15 Date S k') I 10
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