OPNTE#o°t-s ~.1c66 Harnett County Department of Public Health 2 0 8 3 8
PERMIT # aft j Operation Permit
New Installation K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: LsmnjQLx- ~isacc~,p
Name: (owner) ~A~,r~3 L a..•~, r~tioQcrE ~S SUBDIVISION VoctE3-% Gz,"ts LOT # K)
System Installer: C"V~FP- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ community Public ❑ Well Distance from well feet
System Type: Z116 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) J Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims spcem nas Deen msraueo in compuance wIm applicable North larolma General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Construction Authorization
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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 ❑ NoA
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 -'~14£ "\fS Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch $D feet ditches 3 feet ditches M-30 inches
French Drain Required: fe owwUe GtAv&
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This load of tire chips is from the Fuel Grade location and meets the Nc specftat{on as
stated in Innovative Wastewater System approval IWWS-2002-03R km *0 CUP
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