OP RHTE# ra-5-aY*)7, k Harnett County Department of Public Health
PERMIT # cZ S° i _7 8 Operation ~Perrmitit 2 2 2 4 7
New Installation lfd Septic Tank FT' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: d3 w
Name: (owner) 01-'A SUBDIVISION LOT # i~
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: j . 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
U ~ -IJ
rtKMI] LUNUinuNS:
1. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewag ,disposal system on the above captioned property.
Type of system: El Conventional U, Other T% /'c- C-r/ 4l Septic Tank: /COO gallons Pump Tank: gallons
Subsurface No. of exact length Q width of depth of
Drainage Field ditches -3 of each ditch 8 0 feet ditches- feet ditches /8 inches
French Drain Required: Linear feet
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Authorized State Agent Ile C-~V Date /l~ ~l~
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This toad of tire chips 11s from the Fuel Grade location and meets the Nc swwCaffon as
stctgci it inoovitive Wastewater systnnn approval IWWS-2002.03R for Me chip
SuOstitution for Rock Aggrogrote in Nitrification Fields.