OPHTE# 10-$-4,H343 Harnett County Department of Public Health 21 516
PERMIT # 3--~ Operation Permit
New Installation Septic Tank O Repair Nitrification line
wui,oc,~ ELF C' ,s-ca, L~, 0 Expansion
PROPERTY LOCATION:
Name: (owner)s N E~~~ Gu r,~ G 5 SUBDIVISION -`~RL_Sr Q.~~ LOT # I ('tl_
System Installer. C>-v -s S-~cLNcg.A-f*'N 0 Registration #
Basement with plumbing. ❑ Garage 'K Number of Bedrooms '3
Type of Water Supply: ❑ Community ❑ Public 'K Well Distance from well ta0 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.
Iris system nas oeen mstanea in compuance wim aF
A CCLG`a
north larolma beneral )tatutes, Rules for kwage Ireatment and
and all conditions of the Improvement Permit and Construction Authorization.
1 Co N v EN ~ +ald A L REP A i R-
P~,EA
t0 0
rEnrur wnvriivnx
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 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 X, Other E-Z V1
--0~r Septic Tank: 030 O gallons Pump Tank gallons
Subsurface No. o exact length width of depth of
Drainage Field ditchof ea
ch ditch 7 5 feet ditches feet ditches "Iii inches
French Drain Reouired",Authorized State Agent » - Date -11131 V0