OPHTE# iQ Harnett County Department of Public Health
PERMIT Operation Permit 21 8 8 0
7 New Installation 'Y?g( Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) s.~„cz ~C--s
System Installer: 0-.taj
Basement with plumbing: ❑ Garage 'Z5~ Number of Bedroom
Type of Water Supply: ❑ Community X Public ❑ Well
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: 10orE
SUBDIVISION Q~-~a >ss®1~. -LOT # 'R(7
Registration #
Distance from well t<) 0 feet
Types V and VI Systems expire in 5 years.
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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PERMIT CONDITIONS:
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 ❑ NOX
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 system on the above captioned property.
Type of system: ❑ Conventional l~ Other `'T' rFz%w C=,-\'\ L Septic Tank: ic(o cj gallons Pump Tank: *6M Q1 gallons
Subsurface No. of ~-et~,~achditch xct length width of depth of
Drainage Field ditches t '3,`)<? feet ditches 3 feet ditches - inches
French Drain Reauired_
Authorized State Agent ~a vv v Date 4,11
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Th loon' c° tie rhlps is from the Fuel Grade location and meets the Nc specification as
-I ri ,c l!, s 'vdaste,,ater system approval IWWS•2002-03R for fire chip
Substitution for Rock Aggragrate in Nitrification Fields.