OPHTE#N" X111 -7 Harnett county Department of Public Health 2 0 5 8 0
PERMIT # G Operation Permit
b New Installations W -Septic Tank ❑ Repair,5Z_Nitrification Line ❑ Expansion
PROPERTY LO(ATION:/~
Name: (owner) -~1JPv.kr g OVA) SUBDIVISION LOT # r
System Installer L- MP' e-0 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Suppl : ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: l %tt C / V- t Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owne must contact Health Department 6 months prior to expiration for permit renewal.
nn) )pletn nas ueen instaueo in compliance wlm appocame nortn laronna beneral )tatutes, Rules for
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and all conditions of the
Permit and construction Authorization.
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1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Q
If yes, see attached sheet for additional operation nditions, maintenance and reporting.
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional 1 Other T`~ti Septic Tank: ` ,CJO gallons Pump Tank gallons
Subsurface No. of " exact length width of depth of
Drainage Field ditches of each ditch feet ditches- feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date
Treatment and D
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This load of fire chips Is from the Fu 191 Or~~.n iorrtihn drrd meets the Nc specification as
stated in Innovative Wastewator 0s c,°:.:: PVWS•2002-03R for tire chip
Substitution fof Rock Aggreyrote In Nitrification Fields. . I wu VIA