OPHTE# 6®-5-'Z~®'b'j Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 6 9
New Installation 'K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C~ tv L\.aks
Name: (owner) \A>,..% Q2oc-e,. SUBDIVISION C.v2or~>>J~ S56oN-s LOT #
System Installer: 2..s v,,s cA-gn ' Registration #
Basement with plumbing: ❑ Garage -K Number of Bedrooms 3
Type of Water Supply: ❑ Community IN, Public ❑ Well Distance from well 106 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.
Ihis 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
6~ f
i
Qfc.F ~2 ~ S taovs F_ 1'~'-~
I
FERMI LUNIJI11UNY
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other asr ~-~\4 S Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches o ch ditch 50 feet ditches 3_ feet ditches - OL inches
french Drain ReQuired:,,-- \ Lineas;
Authorized State Agent ~ J\ Date
Thls ;oad nt MM cnlbt Is from the Fuel Grndo location and meats the Nc specification as
0OW01W gMem approval IWWS-2002-03R for tire chip
Subsrtti eon for Rock Aggregrate in Nitrification fields.
1