OPHTE# Harnett County Department of Public Health 2 0 5 2 6
PERMIT # Operation Permit
X New Installation 19, Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:_
Name: (owner) J v ~a ~hs~ors~o oQCLES SUBDIVISION ~Zov~~s LOT #
System Installer Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms _ 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well VOO feet
System Type: `:L\_ o\ 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 i
F nstalled 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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V
PERMIT CONDITIONS-
I. Performance:
II. 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 ❑ No
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 I1 Other 1 1cLL (:-N-\ v~, Septic Tank: _}p0o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f each ditch ;L L~ 0 feet ditches 3 feet ditches 1 3
ear A\ inches
French Drain Reauired
Authorized State Agent ;.S Date a I III CF1
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ctknr t-( . 1 Carc,l i.17:? 1401di.r1g, i_.f_C
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RAY bncy t E ~ ik_A. 1' 1860 LP
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Cori=mar; Noi~~_:?
IN load of ttie china Is from the Fuef Grade location an
Stated in InnoNn' gsfewafer system a d meets as
S"Butlon for Rock Aggregrote In Nitrification Fields. 2M-03R for H1e ch
Cell-17,T,-Al t:. i
ldirtg, LL.C
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16: McKoy T
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fri~ru~~a1 !At.
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T~f-E -2412.0 LB N Iii
il-itlUtA1 Wt
troow~"r , 400116/m
9ACY,ME a
Net: 99P O LP
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ck
Matt-r-ital5
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MPT/ i iwh DFN Tuti .9E
Tore $22.W/Tnn
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unl tip U,-5. s-90Aht-i. t
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This load of fire chips Is tram the Fuel C,!c~e I:acation an
d meets the Nc specification
stated In Innovativo Alo:::owcPar syatc rn upproval IWWS-
2002-03R for tire chip
Substitution to( Rock ApgreWolo in Nitrlrication FleldL
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