OPHTE# 11=J= IR ~It Harnett County Department of Public Health
PERMIT # O b3 V0 Operation Permit 21 8 4 7
ZNew Installation Septic Tank Vitrification Line ❑ Repair ❑ Expansion
tt PROPERTY LOCATION: oQ
Name: (owner) ~T c-sAc.' v&- SUBDIVISION C~ LOT #
System Installer: %-r r' r 2 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community V Public Well Distance from well feet
System Type: ALL 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 Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 speci
fications for the sew a disp
osal system on the above captioned property.
~
Type of system: ❑
Conventional Other
rte.
:
Septic Tank: 1 gallons Pump Tank: gallons
Subsurface
No. of
exact length
ZGQ
width of _ depth of
f
di
h
i
h
di
h
Drainage Field
ditches
of each ditch C
feet
eet
tc
es
nc
es
tc
es
French Drain Required:
Linear feet
foZv i
Authorized State Agent/( 16eV Date b/A
i/ ~ ~i~
r
Th;S i~~d of t ;ye chips Is from the Fuel grade location and meets th® NC specircation as
ve'tJ,:,y er;a;ar sy ierrs';Pprovol iV+Ws•20o-2.03Rfor tlr00ehlp
Substitution far Rock Aggregrat® in Nitrification fields,