OPNTE# I -5 a Harnett County Department of Public Health 24677
PERMIT # 14 i a cf Enation Permi
New Installation Erleptic Tank 14—Ri fication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 131 M;r+erul 5gr;�6 Ln,�ic 1�1xu(E rte. 54'y --0i
Name: (owner) 63g nn LrsnSLr.r¢T,n 2a.. SUBDIVISION Ase rj Pa11ci� LOT # 1-4
System Installer: 'TFsurinn's Plvrnbtny Registration #
Basement with plumbing: ❑ Garage fi r Bedrooms5�
Type of Water Supply: ❑ Community E;-- ublic ❑ Well Distance from well 1—` 14 feet
System Type: 2fi° n e. Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner mu contact Health Department 6 months prior to expiration for permit renewal.
I. Performance:
If. Monitoring
III. Maintenance:
IV. Operation:
V. Other:
'reaement ana
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n,PPNt- Ar"J
ana an mnntnunc m me improvement rermn ono ionswcnon numorimmon.
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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 ❑
H2OLine ❑
Following are the specifications for the sewage system on the above captioned ro
Type of system: ❑ Conventional Other 11 �1t+� Septic Tank: /Dov gallons Pump Tank
Subsurface No. of exact length width of depth of
Drainage Field ditches 5 of each ditch SU feet ditches 3 feet ditches
French Drain Required: Linear feet —
Authorized State Agent Date 05/ 22 z >
PWR Line
gallons
inches
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