OPHTE# ~~),_55a1 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 3 3 3
,l New Installation ;1!~ Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~~IaGGocna~c. Lam,
Name: (owner) )<,N" r,'Lty ~n e_Z0o ApNc-0 SUBDIVISION LOT #
System Installer: L.. AcuL-i 51~~2Q r_- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t O 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.
This 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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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. 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 captioned property.
Type of system: ❑ entional ' Other "T )C26 C.-.-'-, PS Septic Tank:®Od gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch i00 feet ditches 3 feet ditches inches
French Drain Reauired:
Authorized State AQent__ Date C
Central Carolina Holding, LLC
1616 McKoy Town Road
Cameron, NC 28326
Customer: 400086 / Larry Sharpes Sep
Generator: NA / Not Applicable
Dest: DEST: NA / Not Applicable
Truck: LARRYSHARP
Comment:
Ticket: 40023692
Date:5/23/2012
Time:13:30:22 - 13:48:59
Scale
Gross: 43540 LB M OutManual Wt
Tare: 21820 LB M In Manual Wt
Net: 21720 LB
Origin Wastes & Sevices Quantity Unit Rate Amount
OUT / Outbound Loads 1000 of DFM2T/2 inch DFM Ton 10.86 Tons $22.00/Ton $238.92
Total Amount: $238.92
Weighmaster:
Libby Cameron
Driver:
s r4 of fire chips is from the fuel Grade Iodation and moots the Nc specification os
:ovuiiva Viustowater system approval IWWS-2002-03R for tire chip
SU35 ,;ulion for Rock Aggregrato In Nitrification Fields,