OPHTE#10°5-a-~*,-1 Harnett County Department of Public Health
PERMIT ^,)-3 Operation Permit 21 7 8 5
X New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PortoEst-c~ys l
Name: (owner) ~~{xcnt tom- ~~~MS~-S SUBDIVISION 55r.; s -LOT # g
System Installer: ~-1NcLcLn C-~ Q F--(L Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community___ Public ❑ Well Distance from well M Q 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.
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 lonstruction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional A Other 1 to..G. GN-a',45 Septic Tank: 10-EO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches_ of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear
Authorized State Agent Date ~ d
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this load of dire chips is from the Fuel Grade location and meets the n'c specification as
fitaiod in innovative 'ddastewater sys'em approval IwwS 2002 03R for tire qhlp
Substitution tar Rock Aggregrate In Nitrification Fields.