OPHTE# t7q_s ZZa75" Harnett County Department of Public Health 2 0 8 7 3
PERMIT # ZS`I f Operation Pe it l
d New Installation 4 Septic Tank ❑ Repair R Nitrification Line ❑ Expansion
PROPERTY LOCATION::,gtr&o k.
Name: (owner) .'J-'F? + SUBDIVISION LOT # S
System Installer: XV< sa*wa-", Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community d Public ❑ Well Distance from well 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.
IRIS system nas been mstahea in compliance with applicable North Carolma General Statutes, Rules for~ewage Treatment and
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all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. 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 spp ifications for the sewage disposal system on the above captioned property.
Type of system: U Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch s~U feet
Septic Tank: gallons Pump Tank gallons
width of depth of
ditches 3 feet ditches f1a inches
French Drain Required: Linear feet
Authorized State Age ..rat Date 9 a 5
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