OPHTE# ILl 5-3351 Harnett County Department of Public Health
23845
PERMIT # a' OQ)Operation Permit
New Installation �R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C�x 0 C,6 Q�D
Name: (owner) 1 1d Cobra$ IN G SUBDIVISION Qw-r+.oygT LOT # 1144,
System Installer: Qui s S 1;LNuK-s—NwD Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well lC") o feet
System Type: M c_ Types V and VI Systems expire in S 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 appllable North Carolina General Sumter, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal ,sistem on the above captioned properly.
Type of system: ❑ Conventional Other t Z F'+..y orf Septic Tank: I Q) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field SII I of each ditch 21A 0 feet ditches _ feet ditches inches
French Drain Reouirei zzz--- Linear feet SF _ N sT v MP, H
Authorized State Agent_ �' �� »�`��:�H7 Date I) )2t) 1.5—
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