OPHTE# 11-.5-- J--) 1,37 Harnett County Department of Public Health
PERMIT # 3 aeration Permit 2 21 7 2
E[ New Installation Septic Tank [Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1'Z zxr,/- f fns., /a.
Name: (owner) ^u 5- SUBDIVISION J~ub LOT # t
System Installer: rr✓ ~G~~~~n e Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community [Public ❑ Well Distance from well feet
System Type: 1Z G 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 LI\I 111 l.Vl\VIIIV ICJ.
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 ❑ PWR Line
Following are the specifications for the sew a disposal system_o~J the above captioned property.
Type of system: ❑ Conventional Other Zg r Septic Tank: /°Q0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch l feet ditches -3 feet ditches inches
French Drain Required: Linear feet
Authorized State Age _ Date /d 4/2
/l.s-, 2-11-11
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28326 14:48:00
Cuet omen: 400086 { Larry ha e Sod _ HA 1tMnnU-,1 " t.
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This load of fire chips is from the Fuel Grade location and meets the Ne specification as
stOn,11 ~r'nnovahve Wastewater system approval IWWS-2002.038 for tire chip
Substitution for Rock Aggreprate In Nitrification fields.