OPHTE# S ®--~-~s~ ~S Harnett County Department of Public Health
PERMIT # C) Operation Permit 21 9 2 3
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) `~lo~c~a mAC~~i ~o m&_s SUBDIVISION C'_p,~i..\,Ivx Sz_cas0,4_5 -LOT # 19
System Installer: `iP,cZoL11 C.Pz,`~ ecZ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms t- li
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S® 0 feet
System Type: 7'~= cn 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the improvement rermt and Lonstrucnon Aumonzanon.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposalstem on the above captioned property.
Type of system: ❑ Conventional Other 112X- C-i\ -\9 Septic Tank: 1(b° ® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch aC)O feet ditches 3 feet ditches inches
French Drain Required: feet
Authorized State Agent Date 1
This lord cr-hre chips Is from the Fuel Grade location and meet; the Nc specification as
stA--: to .-Pv vu,, re W-,;;,,vf<ater system upprova; iWWS-2002-03R for tire chip
Subshtutron for Rock Aggregrate in Nitrification Fields.