OPHTE# Oq-S-a-a54q Harnett County Department of Public Health 21 0 8 9
PERMIT # X51 5 Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1J ¢sF y 9--o
Name: (owner) C.,o,.r,N CSS La<.,a OE„,Pc~,raC SUBDIVISION LOT # 1$C-,
System Installer: C~ L Gem uL- Registration #
Basement with plumbing ❑ Garage X Number of Bedrooms 21
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tw feet
System Type: 711C 0. 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 Generai 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.
II. Monitoring: As required by Rule .1961.
III. 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:
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other T ct C ~a~PS Septic Tank: ►0 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of of each ditch 190 feet ditches feet ditches inches
French Drain Reauired:~ - ~linpnr'faa~'t`
Authorized State Agent \ ~~~,5 CoL1vEx \Ol`f•`~b) Date
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This load of fire chips Is from the Fuel Grade location and meets the Nc specllicaftn a/
dated in Innovative Wastewater system approval IWWS-2002-DU for fire chip
lhrbdWIM for Rack Agyregrats in Nlhlflcaflon WdA.