OPHTE# J/-s"~3 'IV Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 4 2
[af New Installation D~r Septic Tank Li'-Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L-'
Name: (owner) : J 1 SUBDIVISION T E. 1ct~,4jt,, LOT #
System Installer: L,!~:~ r at p~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms d.
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: l1. &fi 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.
ims system nas Deen mstaneo in compliance witn applicable Norm larobna heneral )tatutes, Rules for )ewage Ireatment and Disposal, and all conditions of the
Permit and Construction Authorization.
r
1
0 1
t~4
i ~
d t
tY
rr.nnil WNUi11M:
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 ❑ No
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 sews disposaastem on thg above captioned property.
Type of system: El Conventional Other / /-/"C, "0 Septic Tank: /600 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
trench Drain Required: Linear feet
C-
Authorized State Agen eA-w Date e~nff
r9
mF#
x
r
r
1
T
,
y
,
s ~
i
TMs toad of fire chips is from the Fuel Grade location and meets the Nc specification as
stated In Innovative Wastewater system approval IWWS-2002-03R for fire chip
Substitution for Rock Aggregrate In Nitrification Fields.