OPHTE# f0-5-an Harnett,unty Department of Public ea►,,i 21 4 6 2
PERMIT # a5l"JoS Operation Permit
New Installation ~X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: +N ~E. t ~Lo
Name: (owner) C>_A~C-~ocs Le.s c, SUBDIVISION JpvrNo Ns ~o, rr LOT # 15
System Installer: L--f%cLQ-H S Y+acLjFG-. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 17,1-)'\\ - wsca.ow ` 1AV-0 p DO-)14 4 .+Nse +a-.S
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: =3z-- 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.
]his 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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DCDMIT rAkIn ITIMIf.
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:
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional >k Other -I t qF- C. a -,q-, Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches - I of each ditch 21,o0 feet ditches 3 feet ditches ate-- inches
French Drain Reauired: I ina fPPt
Authorized State Agent Date 5 ,
7`
Th`s toad ci ' I chfps is from the Fuel Grade location and meats the Nc "ciffcwioq as
st , in lr,r:cvotive Wastewater system approval IWWS-2002-03R for fire chip
Suwiluticn for Rock,Aggregral® In Nitrificatlon Fields.