OPHTE# ~ - af~s~1) Harnett County Department of Public Health
PERMIT # a~~6 Operation Permit 2 21 0 2
New Installation 'X Septic Tank Al Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N 'RID
Name: (owner) t="s1NQn SUBDIVISION -Ce~aGE i.t c.r. LOT #
System Installer: L_p,2q;-) S'i8 N05- Registration #
Basement with plumbing: ❑ Garage 1< Number of Bedrooms 3
Type of Water Supply: ❑ CommunityPublic ❑ Well Distance from well t O d feet
System Type: rA 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
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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: PL.;Q"2, ~a'S 5~s1 o ®u-~ ~N~~ C5v 0 yE+ r.TC E2r.~r
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on L-1 bove captioned property.
Type of system: ❑ Conventional Other -t (e E P 5
Subsurface No. of exact length
Drainage Field ditches t of c~ h ditch feet
French Drain Required: ® Z_ sz ~
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: 1 oe, v gallons Pump Tank: gallons
width of depth of
ditches feet ditches Q-4-40 inches
Authorized State Agent Q-C\ Date
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77 77 . -777
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This 1^.^d of fire chips is from the Fuel Grade location and meets the Nc speolftcallon as
'.`1as14 .,tiler <_Yveni approval IWWS-2002-03R for tire chip
u for Rock Ageragrate in Nitrification Fields.