OPHTE# t1~S la Harnett County Department of Public Health 21 0 7 4
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Hwy arl
Name: (owner) S Li >6 SUBDIVISION L- P\k6,F NeI-P LOT # _
System Installer: C>--v ,s`~,~ac to-Cla Registration #
Basement with plumbing ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 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.
In's system has been installed in compliance with applicable North (arolina General Statutes, Rules for kwa a Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No X,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. TP+N c }I ~N~ C~.CcxEp 8y CS V r ~cTY I ~U6 ~i,~ a 6~,~o GtGcY1 3 .c`i~ o°~
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other `~ta,6 Septic Tank: [no 0i gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3. of each ditch 1 o O feet ditches feet ditches inches
French Drain Reauired: _ - tom fAat
Authorized State Agent Date
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Thls load of tire chips is from the fuel Grade location and meets the Nc specification as
stated in Innovative Wastewater system approval IWWS-2=-03R for tire chip
MAWim tot Rock ASWegiaW In Norificatlon fleldta.
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