OPHTE# 16-5-51M3 Harnett County Department of Public Health 24310
PERMIT # QL19-^t'1 Ooeration Permit
( New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
D PROPERTY LOCATION:
Name: (owner) P'orjAL �ats .'DIAG 1�P SUBDIVISION 1Ns �aL�A.E LOT # 2,3
System Installer: ®e�N s I'4cQL a� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L{
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1W feet
System Type: 131c:) 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.
This system has been installed in compliance with applicable North Carolina General Siawtes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consmuction Authorization.
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PERMIT CONDRIDNS
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 ❑ NA
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: ❑ Conventional Other 'F—Z view Septic Tank: T "0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc e 3 of each ditch 10S feet ditches 3 feet ditches inches
French Drain Requir I*ir feet
Authorized State Agent N� »v�� R ,S Date
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