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OPHTE# 09-~~.tldJ3~ Harnett County Department of Public Health 21 0 8 7 PERMIT # Uperatlon Permit New Installation A Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion PROPERTY LOCATION: ►+~.LP~vv1►s> e-D Name: (owner) .o©GS~M'~ AsSacsr_z SUBDIVISION eve-iAcL Q~~.p ass P v LOT # o~ System Installer. E.L vis Registration # Basement with plumbing: ❑ Garage X Number of Bedrooms 3 Type of Water Supply: ❑ Community ❑ Public X Well Distatice from well ► 40 feet System Type: a 'S` -4G) 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 srStem US Deen Instanea in with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. 1167/ 301~' ' o[ouir fA11fl IT1/~11f 1. Performance: II. Monitoring: III. Maintenance: IV. Operation: V. Other. System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ NoX If yes, see attached sheet for additional operation conditions, maintenance and reporting. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional X Other I tieE C_ty~PS Septic Tank: ►d00 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field Ice of each ditch X70 feet ditches 3 feet ditches inches French Drain Required: _ I I infpPr Authorized State Agent I! Date sty.. a.o%4$ 11~Sf'%. ,I ~.13io_ la'r~, joo Sri JIM AII k.1 la(3Y T,..ill}f.f N* load o(tfre chips fs from the Fuel Grade location and meets the Nc .specHlcaMon as Ooted In Innovative 4w.towater system approval IWWS-2002.038 for the chip *jbWAdW4oi Rock Aggagrate In Mi McWlon FletcM,