OPHTE# Harnett County Department of Public Health 21078
PERMIT # X5'-1"7 Operation Permit
New Installation X Septic Tank ❑ Repair'X Nitrification Line ❑ Expansion
PROPERTY LOCATION: e~ N E 2
Name: (owner) Wc~v~rt ~e.~,er^ `NC SUBDIVISION LOT
System Installer: M~t~~ S~MP~nN Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms 3
Type of Water Supply: ❑ Community )5~ Public ❑ Well Distance from well k00 feet
System Type: c 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.
a ~pscw ud uren msraneu in
with applicable North larolma General Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and construction Authorization.
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PFRMIT rnNnITI0Nt-
I. 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 ❑ NoX
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 the above captioned property.
Type of system: ❑ Conventional Other -Ttn.r- (ZA\P-, Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 4 of each ditch 4,0 feet ditches 3 feet ditches -),4inches
French Drain Reauired: foot
Authorized State Agent N%-, s
Date Id~%'t10
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This load of tire chips Is from the Fuel Grade Wootton and meets the Ne speekfea*m 0!
staMd in Innovative Wastewater sy'Oem approval IWWS-2QQ2,93R1or Wo chip
Substitution for Rock AMOV014 in (iltriNcdlw FW&
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