OP RRHTE# M-s-aK~ISee. Harnett County Department of Public Health 21 1 0 4
PERMIT # X5335 Operation Permit
New Installation 'X~ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: C zc-_Ysytt_g_
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Name: (owner) ~A~ t_v ~N v ES-tM~N~S SUBDIVISION -7:7AV,_\ N 0 AV-5 LOT # 3
System Installer: J off N U v . ~a y Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well too feet
System Type: ra 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatmen and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
Ill. Maintenance:
IV. Operation:
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
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other ~2E CX\ ~P5 Septic Tank: _t c)C>O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches !fiof each ditch C4i5 feet ditches 3 feet ditches $`la inches
French Drain Required: r foams
Authorized State Agent `Z& 5 Date \1
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Central Carolina Holding, LLC Ticket: 40015218
:
Date: 1
j , : 0 099::A 28:01 :01 - 09:44:48
1616 McKoy~Town Road Lime
Cameron, N_ 21332E
A O
GrOMS:31280 LB M Uuk Manual Wt
Trunk: LATE C Tare:22400 LB M In Manual Wt.
Customer: 400000/GATE (-XISTOMER Nat: 8880 LB
Truck Type: Pic
Materials 64Services Quantil
100% of DM2T/2 inch DEM To 4.'
Drivar f47
Unit Rate Amount
Tons $22.00/Ton $97,68
Total Amount:
stet: ~
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$97.68
Libby C meron
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Jhia i0ad of }!ra chips Is from the fuel Grade location ~ ~"?Rated in Ir,rovati•0e Wasieyaater system a meets the Nc speclllcotion as
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