OPHTE# I j—s--W'IS3 Harnett County Department of Public Health 24847
PERMIT #,79,596 0 eration Permit
Ld' New Installation 2Septic Tank 2Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 24 41se� ip�, S2 yjda�
Name: (owner) ;ur�lc Aorva Prq, 4 c4_ J SUBDIVISION p, ,,dam LOT # L-4
System Installer. Rac«yc Registration #
Basement with plumbing: ❑ Garage [j--rumber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Well Distance from well �A— feet
System Type: 6% rL" d t Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 0 r must contact Health Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Construction Authodestion.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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.
❑
trench
D -Box ❑
Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage dis osal
system on the above captioned
property.
Type of system:
❑ Conventional t erer
vC/.,� "[T
�
T—Septic Tank
LG4�c.� gallons Pump Tank gallons
Subsurface
No. of
S
exact length
iS
width of
depth of
Drainage Field
ditches
of each ditch i60
feet ditches
3 f..e aie.h., J/-
/
trench Drain Required: linear feet
77
Authorized State Agent f /� �� Date