OPHTE# I0 -5-Harnett County Department of Public Health 21 51 S
PERMIT # a 6 Operation Permit
New Installation U, Septic Tank ❑ RepairA Nitrification Line O Expansion
PROPERTY LOfATION:
Name: (owner) g ~ -~L SUBDIVISION ~'p`~o oS dos •-rt LOT #
System Installer: ¢rc SH o~zR~ Registration #
Basement with plumbing: ❑ Garage"R Number of Bedrooms
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.
13 >rxciu iw ueeo nmaneu in compoance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
c C3 u rn4 ~ ~ 7.5`~e I
Sb x36 ~
r
wv s'
av
c
PERMIT CONDITIONS:
I. 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:
V. Other.
following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional ( Other S icE- Cm \f,3 Septic Tank: 100 o gallons Pump Tank: >U00 allons
Subsurface No. of exact length width of depth of g
Drainage Field ditches of each ditch 3po feet ditches 3 feet ditches I~-alb inches
French Drain Reauired:
Authorized State Agent_ Date _711~d 0
u"
1
'tom.:,;
14
ate. ~
c. `f ♦1 Y .'fri'~ ~ _ } Tom- ~ ~ ~ M
~k *11
a
,4.
~an+
} so s _
u,
OVT
- r'1 y. ? rte. 9.14 {
✓y
This c~;P' is from the Fuel Grud5 lo-atlcj cnd meets the Nc specification as
stated it :n.x v Wcsf~vactbr sysf nl approvai IMNS.2002.0$R for tiro chip
Substitution for RockAggrograto In Nitrification Fialdt. -
x~.