OPHTE# I -� -�� '► Ha,,Iett County Department of Pubk Health
PERMIT # , Operation Permit 22670
I/ New Installation IR' Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: fix. Zeec, tee. 2aS
Name: (owner) - 2 ZZ& SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ G rage mber of Bedrooms
Type of Water Supply: El Community Public El Well Distance from well " } feet
System Type: Tv 7 Z:13 d VI Systems expire in 5 years.
(In accordance with table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
-1-- --r
This system has been installed in compliance with applicable North Carolina General Statues, Rules for Sewage Treatment
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
G
all conditions of the Improvement Permit and Construction Authorization.
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.
fir
2'� C4 -�
,r
❑
D -Box ❑
Pump ❑
Alarm ❑ 142O1-ine ❑ PWR Line
Following are the specifications for the sews disposal
system on the above captioned property.
9 a
Type of system:
❑ Conventional Other
Z
Septic Tank: J00 0 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch i ° feet
n
ditches S feet ditches inches
French Drain Required: linear feet
Authorized State Age t Date 6--3f —13
13- 530881 (1)
13- 530881(2)
13- 530881 (3)
13- 530881 (5)
13- 530881 (6)
13- 530881(7)
13- 530881 (11) 13- 530881 (12)
13- 530881 (8)
13- 530881(9)
13- 530881 (10)