OPHTE# \0'S•x~-, Harnett County Department of Public Health 21 4 8 6
PERMIT # Operation Permit
.K New Installation M Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: - "6Ej 'V-.~p
Name: (owner) P.Q C:0-r:rm c<AIN ` SUBDIVISION \ LOT #
System Installer. 1 F~ S Qc~,PE Registration #
Basement with plumbing: ❑ Garage"K Number of Bedrooms 3
Type of Water Supply: ❑ Communii-- Public ❑ Well Distance from well feet
System Type: - ~1-~ 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.
wo ~yneni nal ueea ummieo in compliance wim
norm tarouna 6eneraf Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1 Lill 111 WIWII IVI\J.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional1 Other L n -C Goa ~f~ Septic Tank: 10 0 e gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches - 3 of each ditch feet ditches 3_ feet ditches DLl--) inches
French Drain Reouired: _ iaoaal~fi•ar
Authorized State Agent N`11 ~ R 5 Date G 1 111
ft load of We chips Is froth the Fuel Grade location and mosh the Ne SWNkxfto as
stated In Innovative Wastewatef system approval (WWS-2002-03 t for lire chip
Substitution for Rock Agyregrate In Nitrification Field.