OPHTE# Harnett County Department of Public Health 2 0 7 9 6
PERMIT #Operation Permit
New Installation K Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: AL'yont 0L~~1-a
Name: (owner) 'E2 P-p C-,-n\" G5 SUBDIVISION LOT #
System Installer: Ca-v,,-5 ~ra,rzca owl Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
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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PFRNIT rnunlTlniJ(
1. Performance: System shall perform in accordance with Rule .1961.
11. 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
following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other -TIa-C-- C-\-~ \ P5 Septic Tank: t.0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches I \ of each ditch aZ .,o feet ditches _ 3 feet ditches a'j "30 inches
French Drain Required: h ~
Authorized State Agent Q~ _ Date 8
NAME"
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Ticket: 46014420
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This load of tire chips Is from the fuel Grade location and meets the Nc specification as
dated in innovative Wastewater system approval IWWS•2002.03R for We chip
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