OP RRHTE#M-5-ao1 QQ-9- Harnett County Department of Public Health 21 10 5
PERMIT # aS33~ Operation Permit
New Installation Se tic Tank ❑ Repair4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: ti Tank C-xu r~
Name: (owner) h+v Ec-5 SUBDIVISION S P\-ii L,v,, LOT # a.
System Installer: SoHN ~Ena-,,Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well COb 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.
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wan appucaoie Norm caronna beneral ltatutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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. &i5TepN W`V-: C. Noel as°I. P.~ ovc: ~o ~f g ssF,, ~,Q,Nc 1ys lAu tioty PNy P- R
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Following are the specifications for the sewage disposal system o the above captioned property.
Type of system: ❑ Conventional Other 'TK2-L i,--J 5 Septic Tank: '1006 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Ca feet ditches 3 feet ditches inches
French Drain Required: \ \ Lthear feet
Authorized State Agent \ Q5~-Als Date ' t
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'entral c,irol.i.na Holding, t,t,t,. FlQket; 4Gi:~L~,~1H
1616 Mc:Kc+~ Fc.,wr~ Road Crate: l l / 19!,2009
meror;. MC 8126 Came: Oq:''8:01 - 09:44:08
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Grasa:=12180 LB 14 Ot:t hf_MLial Wt
Trunk: (SATE; '1'_tre:22400 LF M In M-it a 1. Wk
Cwgtorywr: 10000UGATE rIJ TOMER Net: B880 t,E3
Trru:k Type: Pic~,qpj
latex i_<~ 1 .tom rvice Quantit Unit Rate Amount
_-___-__--LQUI}Y~1_DE~'M2'F/2Tinch t.)Ftrl To________-_4 ~ ~__^^'FonsyM$22.QQ/Ton_____-____- $97.68-
. Total Amount: 57,68
Driver: )asptrt W~►1
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This fpoJ cf ;ire chic, is
reefed in bom.he Fuel Grade location ~ ~~~Inrrovat(~e tyasierQ,4 system ra pproval lW meets aloamlutfaw For Rock rlg~pa~ M Nifr 002-03R tfor flr♦ chip f kaflod as
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