OP RHTE# / 3 _ JamHarnett County Department of Public Health
23512
PERMIT # ZSZ63 I Operation Permit
New Installation L' Septic Tank Z Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION:2f�z_; np,2i o; b f es ,
Name: (owner) SUBDIVISION LOT #
System Installer: 1) Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms l'�x3dpb
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: 05Z r fn— r—�� 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.
[his 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 Authorization
rtnrrtt t.veturtwtrs:
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 ❑ 1-12O1.ine ❑
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: Eltiona
Convenl Other —�, -3 Septic Tank: gallons Pump Tank:
Subsurface No. of exact length / width of depth of
Drainage Field ditches ! of each ditch 1 e feet ditches feet ditches 3b
French Drain Required: Linear feet
Authorized State A,�.e L_ . . - -_�-5- �r�"' Date 3 —f S -15
PWR Line
gallons
inches
13-5-3220OR (1)
13-5-3220OR (2)
13-5-3220OR (3)
13-5-3220OR (4) 13-5-3220OR (5)
13-5-3220OR (6)
13-5-3220OR (7)
13-5-3220OR (8)
13-5-3220OR (9)