OPHTE# /I-s"-~ ~b80 Harnett County Department of Public Health
PERMIT # OZ e7 G I Operation Pupa / 2 2 0 4 8
ENew Installation Septic Tank Z Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION: 1y1 ~~6, -J'k
Name: (owner) S~(nn 1l J•~ Ko~~le.~ SUBDIVISION LOT #
System Installer: ~~~ry l~ti~-rpQ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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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1. Performance: System shall perform in accordance with Rule .1961.
11. 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 a disposals stem on t)ie above captioned property.
Type of system: ❑ Conventional Other '`~rpJ' Septic Tank: 0QO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch PO C) feet ditches 3 feet ditches 56 inches
French Drain Required: Linear feet
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Authorized State Agen
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TbN hod of fire chips is from the Net Grade location and meats the Nc specUfcaNon as
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±~ve'~ztewater system approval lWV/S•2002•03R for fire chip
for Rock AgQrograte in Nitrification Fields.