OP RHTE #I/'/- - 3 W -?i2 Harnett County Department of Public Health 23607
PERMIT # Z83 03 Operation Perrot
ZlNew Installation Septic Tank 5 -Nit fication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 74-15 r�
Name: (owner) ya ° Q i SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage El mber of�Bedrr ms Z
Type of Water Supply: ❑ Community L✓1 Public L�' We11 Distance from well feet
System Type: fsir % /pes V and VI Systems expire in 5 year.
(In accordance with Yable V a) et��t contact Health Department 6 months prior to ex iration for permit renewal.
611
This system has been installed in compliance with applicable[o—qT'ff-ali Gen ral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Impr ement Permit and Construction Authorization.
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PERMIT CONDITIONS:n
I. Performance: System shall perform in accordance with Rule .1961. �� y ?6 5' v t r� S
11. 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 ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewaje disposal system on the above captioned property.
Type of system: ❑ Conventional Y Other Z 5% 12�' b 6 t<<2s Septic Tank: 1600 gallons Pump Tank: gallons
Subsurface No. of exact length T width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches Z`% inches
French Drain Reouired: Linear feet
Authorized State WC�-� -Z �%� - Date Z- —2�' `�f5
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