OPHTE# CY5'1 Harnett County Department of Public Health 21 0 9 5
PERMIT # 2s496k Operation Permit
New Installation -N, Septic Tank ❑ Repair4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: Q„n
Name: (owner) c ,,P- L Cgs, U- C SUBDIVISION P2,twL`S~, C Q~L Cs~~S E LOT # 1
System Installer: S~ M ~ j mac.. c~ c i o Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'N Public ❑ Well Distance from well Loo feet
System Type: ASS 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.
ims system nas Deen instanea 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 LI11111 W"VIIrVnJ.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring
III. Maintenance: As required by Rule .1961. Other.
IV. Operation:
V. Other.
As required by Rule .1961.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatib
conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other `jag Gw~,r Septic Tank: t a00 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ;U~ 0 feet ditches -3 feet ditches I inches
French Drain Reauired: I in'"Pt
Authorized State Agent ~\r \ ~j~\\ RL)t \S Date
963
Ca Cal T 5
S'i 1.. i 't-.! ~11~ i' _•1 i-; .q, ' 'tilt:
This load of tire chips is from the Fuel Grade location and meets the Nc specification as
stated in Innovative Wastewater system approval IWWS•2002-030 for the chip
Substitutliori tot Rock Aggregratts In IiikiNcation Fields,