OPHTE# T'V -s -y I0I-4 Harnett County Department of Public Health 24701
PERMIT # --'1f(09 4 eration Permit
New Installation eptic Tank tel- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOLATION: IL M ` Ut a :60r-
Name:
0rName: (owner) w�, n n Con-, r w :�� n c . SUBDIVISION AVS Pn..I --`LOT # 3-!�- J
System Installer: TTS, o � CoA ` S P L M , Registration #
Basement with plumbing: ❑ Garage fiber of Bedrooms
Type of Water Supply: ❑Community I� ❑ Well Distance from well A-,+ feet
System Type: Z5% 2c d -j 'X.0 on
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.
This 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 Aulhorization.
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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.
❑ 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:
El ther �� A=Z& T1L /, Septic Tank / O gallons Pump Tank /.;I 6r) gallons
Subsurface No. of ezact length width of depth of t/
Drainage Field ditches _ of each ditch I asO feet ditches _y� feet ditches vim) _ inches
French Drain Required: Linear feet
Authorized State Agents Date /0/a/dal
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