OPHTE# -s A) 6)a3 Harnett County Department of Public Health 2 0 8 0 0
PERMIT Operation Permit
New Installation ~K Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION: Hi~L G~t~v Q~
Name: (owner) RVLv-sc- SUBDIVISION LOT #
System Installer. ~i xC Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: El Community ' '2~ Public ❑ Well Distance from well k 0(7) feet
System Type: 'i-a:) 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 has been mstallea in
with applicable North larolma beneral Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
1
f
rtKMII LunullluNS:
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 ❑ N
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 a above captioned property.
Type of system: ❑ Conventional ~ Other > ~cLe- twti Septic Tank: t G4 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field 8ttchers- of each ditch feet ditches feet ditches' -34 inches
French Drain Reauired%- np t~{ear
Authorized State Agent N"~ Date 9
'"Pair-
Ae
V i cke t 4001:344
1q(-J,,OY 16: 35
1al, ?8 A 0
L.B
s Tares LB M
hoc, t Lit
Trckc_i;_ TXpe ta.up
i try Uoi t Rate
This toad of tiro chips Is from the Fuel Grade location and meats the Mc speclficatton as
stated in Innovative Wastewater system approval IWWS-2002-03R for tie chip
Subsfltutioa lot Rock Agprograh In Nltrifkatlon FNi&
_