OPHTE# 1Z-, - 3P2-z-4:, Harnett County Department of Public Health
PERMIT # Z-7 2-32— Operation Permit 22672
[ "New Installation 0' Septic Tank 2r Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,7k 1265 5 rlrte
Name: (owner) A 11� � 'JP4 ..A SUBDIVISION LOT #
System Installer: i A Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community L-1 Public ❑ Well Distance from well feet
System Type: 2 %a i C23 ! f 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.
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewap
disposal system on the above captioned property.
Type of system:
El Conventional 1 ew Other
794/n 71R
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
exact length
ditch f� feet
width of depth of
ditches feet ditches ZZ) ft. inches
Drainage Field
ditches
of each
French Drain Required: Linear feet
Authorized State Ag Date —!
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