OPHTE# 1-1-s-4aa%, Harnett County Department of Public Health 24168
PERMIT # a y °?3q Ooeration Perm'
New Installation Septic Tank itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rub G' I s i5t C g cl[ rt ' I I ear S 2 a
Name: (owner) NokzG,c.d_C, SUBDIVISION CokS\Ps 1F, .n LOT # .1
System Installer. Registration #
Basement with plumbing: ❑ Garage �b f Betiro'oms
Type of Water Supply: ❑ Community I +yPublsc ❑ Well Distance from well I OO feet
System Type: '-L a �W s ,iC, (\ `>>S Types V and A 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 Stations, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage ch posal system on the above captioned
Type of system: ElConventional cher C r--1 c —�. pro e Septic Tank: I CX. gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 1I
Drainage Field ditches of each ditch C-% feet ditches 5 feet ditches a"t inches
French Drain Required: Linear feet
Authorized State Agent Date ey'r