OPH T E # O9 -5 ~6 Harnett County Department of Public Health 21 Q 9 9
PERMIT # 21-5-32 r° Operation Permit
New Installation 'f~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
Name: (owner) PROPERTY LOCATION: L.D L'M
SUBDIVISION kcss 1'~c.Ca e,E ~v P,E LOT # ab
System Installer: M ~e S , MQ~ o Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms It
I Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10Cj) 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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1. 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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'mss Other 1 ,gc C,\> \f5 Septic Tank: I 0C5o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch r~ feet ditches 3 feet ditches inches
French Drain Reouired: 'neiiL,feet
Authorized State Agent RZ~A S _ Date it 11-7
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Central Carolina Holding, r AA-' Ticket: 40015179
1016 MrKoy Turn Road late: 11/16/1009
Time: 13:33.15 - 13:53:59
1- aineron, NC 28326
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Gross: 40020 LB M Out Manual Wt
Truck: MTKFSBACKH Tare:21880 LB M Tn Manual Wt
Customer: 900092/MT-ES BACF;HOE 5 EX Nets t 18140 LB
Truck Type: Dump Truck
Materials & Services Quantity Unit Rate Amount
100% of DFM2T/2 inch DEN To 9.07 Tons $22.00/Ton 5194.54
HABNC:/Fabric Out NC 1.00 Units $65.00/Unit $45.00
Total Taxes: $5.04
~Total Amount: $269.59
Driver: Deputy Weighmaster: __.G-- ,i
L.ibbv`Cameron
This load of tire chips is from the Fuel Grade location and meets the Nc speciftcatIAM as
stated in Innovative Wastewater system appr0V0l IWWS-2002-038 lot ike cMp
lubgiiWlon 401 Rack .Agytogfa% In Nli flaatiott Fields.