OPHTE# 4O Js~a~ tid C~ Harnett County Department of Public Health 2 0 8 6 8
PERMIT # r~OV. Operation Permit
New Installation Se tic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) C~yoc s \7E4QN SUBDIVISION L-V- LOT # 5
System Installer: M P,, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1C~ feet
System Type: '=T ga~ 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.
Ibis 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 Authoraation.
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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 ❑ NotX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional P-1~ Other IiQ G~ 1P} Septic Tank: Son6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches --13- of each ditch S O feet ditches 3 feet ditches all 3Q inches
French Drain Required:,.- \ linear
Authorized State Agent Date 4
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Net: 13'160 T3
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?his load of tire chips is from the Fuel Grade location and meets the No sWftok* as
slated in !nnovative Wastewater system approved IWWS-2002-M for tiro ObIP
Substitution tot Rock AggreVate In NlhitlcalM FWdL
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