OPHTE# t � - 5 - 3 A Oy "d Harnett County Department of Public Health
24264
PERMIT # 2 ag s Operation Permit
Cd( New Installation ❑ Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTYLOfATION:S(t lytfl Glhecka 0,4
Name: (owner) 1 j n n C d ns } �� �: a n SUBDIVISION_ A� a, P o �d LOT # $
System Installer: .,mb, AQ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community W Public ❑ Well Distance from well feet
System Type: 7 e Bio Z e a cjc 7y b s 1 i s Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ [onventional Q' Other Acte pJAa ZS°/ Qea Septic Tank t Zd 8 gallons Pump Tank: 1 Z 45o gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S O feet ditches .3 feet ditches -2-Z- 1 inches
French Drain Required: Linear feet