OPHTE# Q) 5 a~,5 Harnett County Department of Public Health
20816
PERMIT # a-ss Operation Permit
New Installation '4~j Septic Tank F-1 Repair X Nitrification Line 0 Expansion
PROPERTY LOCATION: Name: (owner) A4 CoSUBDIVISION 7-t,4&,G LOT # 3` _
System Installer: Laic" 5 orcLP Registration #
Basement with plumbing: ❑ Garage"< Number of Bedrooms
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well \ O~ feet
System Type: =af 61 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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1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Noxl
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other SySsE--, Q'-" bLV-EO 1 Wo.<~L ~u Z vwGtt LANL S<SiZ`te ~F~~ soil-5)0t
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other (-~AN-\95 Septic Tank: t W0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 1 of each ditch t5~ feet ditches feet ditches inches
french Drain Reouired:
Authorized State Agent QGyAS Date 101) 3
NOW
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renlvr: l C ic~k n:~ HiAdi«ttg, L,L Dates 3 '29103@`3
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HC 12, pp 3 If -41 'f itter: 16-.02:04 16: r?3: 20
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Tivf.. k Type; NAMP TIMCk
M,Ate-ri kls ~ 9'evvie•es Ottantity Unit Rate iirucxtvlt:
IC40% c1f W112T/2 rich GF N Tura 10.26 T~arlx VT.OQ/Ton W257. 72
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DFivers Deputy Weaighmaster:
t1 Libby = curl
TMs load of firs chips is from the Fuel Grads Ioco%n cnd meets the Nc spocllipption rst
stated ki 1111wvatlve wasiowate►r system approval IWWS-2002-M for fin C4
SUbstifullon to Rock Aagro"s in N*ftCrtion ftft y