OPHTE #_14 —5 - _�*-A X�3 harnett County Department of Public Health 23547
PERMIT # Operation Permit
J New Installation Se tic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:
Name: (owner) Cum(6cxu_P,Na �-Ac SUBDIVISION C-facz.,JE.>N-5 LOT # 4G
System Installer: i --p Q==-' r N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l®CD feet
System Type: = ' 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.
MIS 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.
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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the abo a capti�d property.
Type of system: El Conventional Other CV1 �x Septic Tank: tO®G gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field of each ditch I 0 feet ditches 3 feet ditches }'% 310 inches
French Drain ReauireZ[. Linea&..feet
Authorized State Agent ��V `� __ Date a )3 11,5-
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