OPHTE#09 - S~-.?,j- 0S-6 Harnett County Department of Public Health 2 0 6 9 9
PERMIT #-?,f-P2 eration Perm'-t
fCI New Installation Lam' tic Tank ❑ Re air riffcation line ❑ Expansion
PROPERTY LOCATION: ~ G.rro~
Name: (owner) ✓ti To~t - SUBDIVISION LOT # If - System Installer: kor'ry Registration #
Basement with plumbing: ❑ Garage ❑ Number of~Bedd oms }
Type of Water Supply: ❑ Communi Public Well Distance from well feet'[ ~ .
System Type:
~ Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
11,15 5pcem nas oeen mstaueo in compuance with apphcame north tarolma 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.
11. Monitoring: As required by Rule .1961.
111. 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 sewoisposal system on th b e captioned property.
Type of system: ❑ Conventional 42 Other -1-"c rZK Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /00 feet ditches _ feet ditches /00 inches
French Drain Required: Linear feet
Authorized State Agent Date 2Q4
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Central Cafolina Holding, U-C Tid-ett ~T~~~}1~+533
1616 MvKuy lug, final' D z 9/13/2009
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Camerl-)vw, )3C 88326 Time: 1P.-19;18
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f7T(~ L.B M D_tt Platrual Wt
7r-+_tck.e LAWV74i(" lq I_tt Tit T), h( rn.tal #G
Custo rvr : <+1:}WM6/ -ARRY SLOT Ik-A LB
T rkick Ti ter?: Wmp f rtic l .
ULAu 1lrt:ity U11ib Rate i~Krlr~isiIt
10~17t C) f 11"l- L11 /2 i ; M "fUn 10.29 Tgrrs $2;?. t t, Yon ^$226.38
Tot4l Awwit: $226.38
Driver: - ~ f7Ey)xcty Wei.ghWASiter:
Libby ~E r~on
This load of the chips Is from the Fuel Grade location and meets the Nc "Cificotl" a$
stated In Innovc lve Wastewaler system approval IWWS•200 -UR fa We C*
f1i~gRrrtion fOS f ek A Q~~ IN NMrM"W Ftelft