OPHTE# 10 - 5- ~6 Harnett County Department of Public Health
PERMIT # 0-4377 '1 Operation Permit 21 8 7 6
New Installation Ilk Septic Tank .k Nitrification Line ❑ Repair ❑ Expansion
Q PROPERTY LOCATION: 'Nc,^"i)2."}
Name: (owner) vr~-riP\6£, Qu-v6 N-\ 005)0 C SUBDIVISION LOT #
System Installer: 'S iA PaR G- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Lll
Type of Water Supply: ❑ Community )4 Public ❑ Well Distance from well \OC1 feet
System Type: =S31 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 Construction Authorization
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FERPIIl LURIJII M:
1. 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.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑
Following are the specifications for the sewage disposalystem on the above captioned property.
Type of system: ❑ onventional Other t - C,-,A ?5 Septic Tank: OVT1 ►L gallons Pump Tank:
Subsurface No. o exact length width of depth of
Drainage Field ditches ` of each ditch 50 feet ditches 3_ feet ditches
French Drain Required:_ Lin Noc•~~o"/
PWR Line
gallons
inches
Authorized State Agent ~1'~ h~5 Date i I I'd)
This 16M of fire chips Is from the fuel Grade location and meets the Nc speclflCaflon Oti
&tc' c!" / %vasfowctor sys"ein approval I`NWS•2002.03111 for lire chip
Substitution for Rock Aggregrate in Nitrification Fields.