OPHTE# ~D-5--a3) Harnett County Department of Public Health
PERMIT # ~r-,~ fl~ Operation Permit 21 9 / 7
New Installation _)R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION S~n-~a ~~LLAe~ LOT #
System Installer: QP_Q,-, Registration #
Basement with plumbing: ❑ Garage %X Number of Bedrooms 3
Type of Water Supply: ❑ Communi 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 has been installed in compliance with applicable North Carolina beneral Statutes, Bules for Sewage Ireatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
PERMIT CONDITIONS:
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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box
❑ Pump ❑
Alarm ❑ H20Line ❑
Following are the speci
fications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other C,v (
Septic Tank: 1C)C) a gallons Pump Tank:
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch feet
ditches _ feet ditches 3~ a
French Drain Reauired:
6iee t
PWR Line
gallons
inches
Authorized State Agent Date C~1:3 1~
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