OPHTE# C)7 I9d34
Harnett County Department of Public Health
21237
PERMIT # a X533 Operation Permit
New Installation X Septic Tank ❑ RNitrification Line ❑ Expansion
PROPERTY LOCATION: KAjjjs P..pcY
Name: (owner) Cua C"N QA (CL~,E,r t2x~ SP SUBDIVISION LOT #
System Installer: C,Q'Z a,-, 1 Erie Registration #
Basement with plumbing: ❑ Garage ❑ Nambe -et 8~tlrmuu 'ja r° rem t ( 5
Type of Water Supply: ❑ Community '5( Public ❑ Well Distance from well 100 feet
System Type: -T-r-r X-, 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 sy$em has peen mstaueo m
with applicable north larohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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30'
30tldstiG
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N01V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional X Other PvL-
,f . Q.BP,rrO&R-
Septic Tank: 1600
gallons Pump Tank: ta50 gallons
Subsurface
No. of
exact length
width of
depth of
Drainage field
ditches
of each ditch C1 feet
ditches 3
feet ditchm I Z - s~ inchac
French Drain Required: a eet
Authorized State Agent ~G*~S Date 6b 6
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