OPHTE# t=ate Harnett County Department of Public Health 24851
PERMIT# of i�a3 0 .ration Permit
D ew Installation Tank D—ftffication Line ❑ Repair
PROPERTY LOCATION: xP _ P 13 Expansion
Name: (owner) M:c,<,a��el � cap �-ir tc C sa <ns\
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System Installer r. odd -61_,_., , ,. _ LOT #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3 Registration #
Type of Water Supply: ❑ Community Q bhc ❑ Well Distance from well —A
System Type: a� r )o ^ 5 s feet
(In accordance with Table V a) Types Y and VI Systems expire in S years.
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 Comm.&&,,, e„e..:...:__
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. 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.
❑ D -Box ❑—Pump ❑
Following are the specifications for the sewage dis osal system on the above captioned property. Alarm ❑ H2OLine ❑
� � PWR Line
Type of system: ❑ Conventional Other (-
Subsurface No. of exact length s Septic Tank I O pp gallons Pump Tank: gallons
Drainage Field ditches 3width of depth of
of each ditch 5 feet ditches 3
French Drain Required: — Linear feet feet ditches oZ6 -� o
inches
Authorized State
Date I. Q/CC �o,�