OP RHTE# 0i- ,f- Harnett County Department of Public Health
PERMIT # �Z_rj 35 Operation Permit 22523
E New Installation C"Septic Tank PNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ,/�k . C�'�� Ch,., JA
Name: (owner) Ck,00 Q ,o SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community O7 Public ❑ Well Distance from well feet
System Type: Cr 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
I
/f I
PERMIT CONDITIONS c
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 ❑ No
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 sews ' disposal system on the above captioned property.
Type of system: ❑ Conventional LEI Other :E; e, 0-k• p.f Septic Tank: gallons Pump Tank: gallons
Subsurface No. of q exact length width of depth of
Drainage Field ditches of each ditch _! S feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent/ Z7/ Date /d // 9 /2 d
Central Carolina Holdings
Ticket: 147785
Date:10/4/2012
Time:16:33:31 - 16:59:58`
Scale)
Customer:
0369830001 / Carter 'Brothe
Gross: 48060 lb Out Manual
Wt
Tare: 26960 lb In Manual
Wt
Net: 21100 lb
Generator:
NA /'Not Applicable
Dest:
DEST CCH / Central Carol'i
Truck:
CARTER BRO
Comment:
Origin
Wastes '& Sevices
Quantity Unit Rage /Unit
Amount
---------------------------------------------------
NA / Not Applicable DFMT116 /Drain Fill Material
10.55 TON: $22.00 /TN
$232.10
Total Taxes:
$15.66
Total Amount: s
$247.76
Weighmaster:
Driver:
Libby Cameron
Thfs load of fire chips is from the fuel Grade location and meets the No specification as
stated In InnOvOtive Wastewater system approval IWWS- 2002 -03R for fire chip
Ilubstifation for Rock Aggregrate in Nitrification! Fields.