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HTE# 0Harnett County Department of Public Health 21 1 6 9 PERMIT # 0 eration- Per it © New Installation Z Septic Tank ❑ Repair Nitrification Line ❑ Expansion PROPERTY LOCATION: ifs cK~• ,-d, Name: (owner) ~ -vt.r SUBDIVISION ~/P} r ~ (o L c,, ~Cer LOT # A--d ~ System Installer: - /1411 vC- L Registration # Basement with plumbing: ❑ Garage &Zumber of Bedrooms Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet System Type: Tr trr Types V and V1 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 General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. r~r ~ r1 t PERMIT rAkinlTlAkl( 1. Performance: II. Monitoring: III. Maintenance: IV. Operation: V. Other. C~ Following are the specifications for the sew disposal-system on the ~b[ove captioned property. Type of system: ❑ Conventional Other Z ~e C hSeptic Tank: /00 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of ditch feet ditches feet ditches - 3~ inches French Drain Required: _ I inT£PP Authorized State Agent_ y~`` ( vs Date Q-1 1v System shall perform in accordance with Rule .1961. As required by Rule .1961. As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ No If yes, see attached sheet for additional operation conditions, maintenance and reporting. pif-S-5-31 Qc;41 /C _ ~ Rm dl 1;111 s,1j! r. 7 k `w 'k sit " Q ka • T ' ,y E f ;r ~ f A 4", r` ~ {W t~f k ~ f x JT 7 aN l ra. 4 / t st Is< 1 Ticket 4001,5140 oat e : 1/2 S12ki1C, ire 03:57 Truck: i X~BB.~'-:RH Tr,ZOC T_. ;uf;x;+raw.- r; 4i'~1xt;j KrF.;xi BACKBrr£ 4 EN+.AIVAT D ,;t: IJAMOt AppiicdbiA "o MV." ut t~aaue l Alr >rct: 9? 3$b LB K (>I; t f f Tare: 21fj8f1 I.B M Z M>XIIael W, ~ t :Vat. MOO I,B Ori~i.n t~gTlG+.xr_borxeu3 ~.cvads fteeria is IWI -A DFM2Tl2 i.xich DrK T,2% Qu%nt it: p 7. f95 TOn,!i rote 13.0c?Tvn .Aron"At 3 172,70 Tots i Ae tmt.: S 172.70 { Eilgd x ~ xL M i gbalA » t'r: L "Y 1 ITIG" sour i ; This load of tire chips Is from the fuel Grade location and meets the c spe stated in Innovative Wastewater system approval IWWS 2002 03R for lira chip Substitution for stock Aggieprate in Nitrification fields.