OPHTE# t i Harnett County Department of Public Health
PERMIT # a-(-z~SSL- Operation Permit 22021
New Installation Ik Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOfATION: L.vc,?s Rx~,
Name: (owner) K,,c-ANQt_ C (L)15SdM SUBDIVISION o iA rryC LOT # I
System Installer: L-Antsy S»RqLk' C, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'I Public ❑ Well Distance from well lE7~ feet
System Type: 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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rs:nrui Lviwuivns.
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 ❑ NoIX
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 disposalxtem on the above captioned property.
Type of system: ❑ Conventional Other G ►2 C C-'% Septic Tank: QQ0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 7
Drainage Field ditches
'D of each ditch feet ditches feet ditches inches
French Drain Reouired: c~ ~~LI
Authorized State Agent qo-Y 5 Date
This load of fire chips is `Tom the Fuel Grade location and meets the No Specification as
Stated in iwovcfive Wastowater system approve! 1WWS•2DD2-03R tot Ike ctup
Substltution for Rock Aggregrate In Nitrlilcation FWds.