OPHTE# -S-=-2-a;~-46 Harnett County Department of Public Health
PERMIT # a y~q 9 Operation Permit 2 21 7 3
LY'New Installation _ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: RQjD--?.r P%7`- mc,, /e-J_
Name: (owner) (for/-Jo, Jo "C_ke z. SUBDIVISION LOT #
System Installer: 1. -rr y 'MwrPe Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms 3
Type of Water Supply: ❑ Community Z' Public ❑ Well Distance from well / oe feet
System Type: z G 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 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:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 91
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional 1Z Other `r-e. Ck, 9 Septic Tank: l G G gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /OU feet ditches feet ditches 18 2 inches
French Drain Required: Linear feet
Authorized State Agent ZZLy~._,/t'L%.~ Date -J / Z.2, -/Z_
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Thee'"d Of tire chips is from the Fuel Grade location and meets the Nc specification as
1' °~r^v VGs'OW'QtOt SYst:32-1 a,pp,nval IWWS•2002.03R for tire chip
Sur - Afwr! inr Rock Aggtegrato In Nitrificatlon Fields,