OP RHTE# /G' 5-- 3RS 4 4 K Harnett County Department of Public Health 24360
PERMIT# Z°Iog7;/ Operation Permit /
2' New Installation Septic Tank Q Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:BnJ437 A3AGCtr, W.>D
Name: (owner) ( !L A6,_,, SUBDIVISION LOT # 1—
System Installer. I r_C> Registration #
Basement with plumbng: El Garage 12/ Number of Bedrooms
Type of Water Supp' El Community ;/Public ❑ Well Distance from well feet
System Type: 2'S.'/6 Rvczztr,Y S tG,--_Ts 6 —vP 4.- Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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Iris system has been installed in compliance with applicable North Carolina General Statutes, Rules for,�gr Ugcmem and Disposal, and all conditions of the Improvement Permit and Construction Authorisation
Mini CUNVIIf(INS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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VI5
25' sc'
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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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned properly
Type of system:
El Other ZSo/n =1%) o -z ati- A"`�"s' Septic Tank ! Z S D gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches .3 feet ditches inches
French Drain Required: Linear feet
Authorized State AgentJ�� Z ��iih✓���µ Date 3 - 2u - 11
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16-5-3g514R (1) 16-5-3f514R (2) 16-5-3g514R (3) 16-5-3j 514R(4) 16-5-31!514R(5)
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16-5-34514R(6) 16-5 3X5 14R (7)
16-5-3014R(8) 16-5-39514R (9) 16-5-3�414R (10)
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16 5-3¢5514R (11) 16-5-3J514R (12) 16-5-3 J414R (13) 16-5-f14R (14) 16-5-1514R(15)
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16-5-3 14R (16) 16-5-31514R (17) 16-5-3*514R (18) 16-5-3� 14R (19) W � 16-5-1514R(20)
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16-5-3� 514R (21)