OP RHTE# -S-2Z,?7e Harnett County Department of Public Health 21 0 2 3
PERMIT # ZS76(- eration Pe It
New Installation Septic Tank ❑ Repair Nitrification Line El Expansion
PROPERTY LOCATION•Se /y1r) or ~~trc~r 2,d
Name: (owner) Z~uZA ime SUBDIVISION Tb gru LOT
System Installer: 1 Registration #
Basement with plumbing: ❑ Garage /Number of Bedrooms .3
Type of Water Supply: ❑ Community Gd Public ❑ Well Distance from well feet
System Type: Z 50% yyixt,--%; lc6-,... 7r',', U; G ~zt~i Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
1. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other .15%, &70 Ltd did Septic Tank: c~na gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches /8 inches
French Drain Required: Linear feet
Authorized State Age6t _ lip, Z lq"w ' Ap- le-3
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