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OPHTE#©a s - aril i Harnett County Department of Public Health 21 10 9 PERMIT # as ti Operation Permit New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion PROPERTY LOCATION: Name: (owner) R:) \ L- L- C-+-o.o_v~ fit; m, --5 SUBDIVISION Pw~b~s Qo~*d LOT # g9 System Installer: ►-o~-i S»a~ Registration # Basement with plumbing: ❑ Garage Number of Bedrooms _3 Type of Water Supply: ❑ Community Public ❑ Well Distance from well \©d 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. Inns 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. C\1 tU oaa~NV.~~. ~o~L- M6~.rr5 1 e ~ r,e ~d ~ a3i A Q l3C V W C DCDMIT rAAINTMUC 1. Performance: II. 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 If yes, see attached sheet for additional operation cc maintenance and reporting. Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional '9~ Other ,FTv a-24--co Septic Tank: lood gallons Pump Tank: VOOO gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch 3CX~ feet ditches feet ditches a4-19 inches French Drain Reouired:.facr Authorized State Agent_ f -Q~ Date k\ 3 1616 McKoy Town Rofic4 `'~Imeron, NC 28 ?246 Ticket: 40015176 Efate: 11/16/2009 Time: 21:42:14 - 1.2:09:29 A U 'Ruck: DC'CARTFR Gross: 4-1820 LE M !oat: Manual Wt CU.Aomer: 400100/D.C. i,ARTRR CGNSTR Tare:426980 LB M 7n Manual Wt Net.-I.6840 LB Truck Type: Dump Truck Materials & Services Quantity _ Unit R,itri Amount 100% of DEN _ _ Tit inch DFM To 8.42 Tans -422.00ITonww-- $185.24 Total Aaaunt: $185.24 Driver: "_.r..~-"~~Deputy Wei.ghmaste r: r" Libby C.'artier~n t ~ M load of tire chips Is from the Fuel Grade location and meets the Nc specificoll" cis :dated In Innovative Wastewater system approval IWWS-2002.038 lay tits chip SowttIIL4i*n fa Rock Aaprsprah In NlhfBcation Fields. C ~T