OP RRHTE# \i3-5- 401P'S . Harnett County Department of Public Health 23131
PERMIT # `� L Operation Permit
New Installation IS\ Se tic Tank Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Srs tns'N ON SUBDIVISIONiaoy,G- ��t. -QTr -ca, � LOT #
System Installer: o I y �'T-�4N C i: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well C1 0 feet
System Type: 11 _ �A 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 Larolma beneral )tatutes, Rules tar )ewage Treatment and Ulsposal, and all conditions of the
102 O
PERMIT CONDITIONS:
I. 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.
Permit and Lonstruction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E'Z�u��r Septic Tank: } CaCi C7 gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field tldtitt�s— k of each ditch BOO feet ditches feet ditches
French Drain Required: et
Authorized State Agent � �� `� Date 1lz1tll1-i
PWR Line
gallons
inches