OPHTE#~O -s-~~4-7 Harnett County Department of Public Health
PERMIT # a6 oa Operation Permit 21 5 8 3
New Installation X Septic Tank ' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) CumsEaLLP,,, SUBDIVISION C~ LOT # So
System Installer: Efl aow n1 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: G 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.
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PERMIT CONDITIONS:
with applicable North farolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
5 U N 'OV\ G
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captione4roperty.
Type of system: ❑ Conventional Other G\Pcr,9ry~~
cc~ Septic Tank: t bC70 gallons Pump sank: gallons
Subsurface No. exact length width of depth of
Drainage field ditches of each ditch _L_ feet ditches_ feet ditches a Li inches
French Drain Required: ar feet
Authorized State Agent " RZ ~"A5 Date $ l o) to
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