OPHTE# 19Z- Harnett County Department of Public Health
PERMIT # �'�l Operation Permit 22796
New Installation K Septic Tank IX Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:~
Name: (owner) Spy yy SUBDIVISION kt x-A P H LOT # 45
System Installer: e. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi 'K Public ❑ Well Distance from well �O ® feet
System Type: 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.
ims system nas peen mstauea in compuance wan appucaaie norm Larouna Ueneral )tatutes, Ames for )ewage Ireatment and
M
and all conditions of the Improvement Permit and Construction Authorization.
rtnrlll LUNL)IIIVN):
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes El NoIN
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewage dispos system on the above ca tioned property. Mil
Type of system: ❑ Conventional Other t)�1P`� o t --2-- V.i c, ,. Septic Tank: � ®bd gallons Pump Tank: 0m gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch p� d feet ditches 3 feet ditches 20 —36 inches
French Drain Reouired: _ _ Lineal --ket
Authorized State Agent�'� �`��; TM��S Date 3 a l