OP RHTE#O'7rJY /7 y3,ZC Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 01 1
V'New Installation Imo` Septic eTank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:-
Name: (owner) s C~,~d ~c . Wy SUBDIVISION sad P~. LOT #
System Installer: r ec„ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms .3
Type of Water Supply: ❑ Community F.~r Public ❑ Well Distance from well feet
System Type: 1I~ 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.
l" I
A14
tV
r~ C-
~J
c
r ~F
nrnu~T rnun~r~n ur.
~ ~nuu wnvnivn~.
1. Performance: System shall perform in accordance with Rule .1961.
Il. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew dispos system on tt!bp,above ptioned property.
Type of system: ❑ Conventional Other 1,1, its Septic Tank: gallons Pump Tank: ! gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches .J of each ditch /00 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age t Date i /"aiv
11
3
`a
t
~
, ~
f ~ a,>
y. '?118
~ 5:;,
•
~
..,"g
,
I
N,
_
x
W-W
`V
t k s.* 4 Mkt 1~ 8
'iy
~
r
e
~ j m
t
s
N
5
w
44
~
Ns load of tire chips Is from the Fuel Grade location and meets the Nc speclficatlon as
stated in Innovative Wastewater system approval IWWS-2002.03R for tire chip
Mstifullon tot Rock Aggregrate In Nitrification Fields.