OP RFITE# Q7 -c5'o7,1 60 Q/Z Harnett County Department of Public Health 2 0 6 8 6
PERMIT # ~9.5-a "-y Operation Permi
C'New Installation [peptic Tank 0 Repair Er"Nitrification Line 0 Expansion
PROPERTY LOCATION:
Name: (owner) t3 y "A L"- SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing El Garage Number Bedr °ms 3
Type of Water Supply: ❑ Community ❑ Public 1X Well Distance from well 00 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.
ims system nas peen mstanea 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:
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Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 2'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sews disposal sy~`stem on th above captioned property.
Type of system: ❑ Conventional Other 7,`,^e. C k.I Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 80 feet ditches feet ditches inches
French Drain Required: linear feet
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This load of tire chips is from the Fuel Grade location and meets the NC tp"KC0t10n as
stated in Innovative Wastewater system approval IWWS-2002-03Rfottt
Substitutba 1191 Rock A9919910li In Nitrtflcation FWOL