OPHTE# Ti-6`413c�F,- Harnett County Department of Public Health 24842
PERMIT # a94S$ Doeration Permi
E"New Installation peptic Tank cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (qv T4t:A�
Name: (owner) C— --r:h, SUBDIVISION LOT # I
System Installer: ---a Registration #
Basement with plumbing: ❑ Garageummbb r of Bedrooms SL
Type of Water Supply: ❑ Community Q� ublic ❑ Well Distance from well feet
System Type: 2:57 c A o ti s .ner Types V and VI Systems expire in S years.
(In accordance with Table V a) must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in eompliana with appliahle North Carolina General Striates, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comtmttion Au horiation.
3c
r-xE1�LLeca.L I
wEK T a
N t`
4¢a+Y Z il T
C:, c.CF 5 F^>
Anfnl
sP oKt
Hart- Sin
Dye —b
7
PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage ddiisp��I system on the above captioned�roperty.
Type of system: ❑ Conventional sewage
c�i y :L slur li}—� Septic Tank: foiF gallons Pump Tank gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches of each ditch t 50 feet ditches feet ditches inches
French Drain Required: linear feet _.-
Authorized State Agent / Date 1 I d 1261 a