OPHTE# o~3 i~►4~, Harnett County Department of Public Health 2 0 5 3 6
PERMIT # - 1Ji5 43. Operation Permit
New Installation 'K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: y tips M, Po
Name: (owner) flEME~~•c. S I`~x~~E. tS SUBDIVISION C.owA,,, S~ p LOT # ln_
System Installer: Rc6` N r,tfl Ce, n ; Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ~I Public ❑ Well Distance from well 100 feet
System Type: o. 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.
ims system nas been mstabea in
wnn applicable north Carolina beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
rt:nrnt wnvuwns:
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 4 Other ~t2E C'\\PS Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche Hof each ditch RO feet ditches 3 feet ditches inches
French Drain Reauired: ar f \
Authorized State Agent4-5 Date
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This load of tire ehlr! Ic frl)m the ^~^d= location and meets the Nc specificallon at
stotad to InnovC" v,l "AlWS-2002.03R for tire chip
Subatftutlvn for 1:+ Fields.