OP.,IE# Harnett County Department of Public Health 24861
PERMIT #-29'5&-4 0 eration Permit
mew Installation Q-Te`pfic Tank cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ /c� sr41A c �n+,� r_ Lvs -V '
Name: (owner) 5 tc ek— s5 , 619- :7,c . SUBDIVISION LOT # a -7
System Installer. -s.--,iAacoc t Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms -3
Type of Water Supply: ❑ Community clic ❑ Well Distance from well °r feet
System Type: a5y 2�d Ya�c s>� 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.
IRIS system ha been installed in compliance with appliable North Carolina Genenl Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conumcuon Authorization.
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PERMIT CONDITIONS.-
ONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage di al system on the above captioned property.
Type of system: ❑ Conventional C3�'Dther ?> rI Qw Septic Tank: /cD-- gallons Pump Tank:gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch —4-6 feet ditches 3 fent dit.h.r a4- ;,,,n,.
trench Dram Required: Linear feet
Authorized State Agent ����✓ Date Id1131aor3
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