OPHTE# o5-S aa~~a Harnett County Department of Public Health 21 112
PERMIT #6S Operation Permit
New Installation Septic Tank O Repair X Nitrification Line 0 Expansion
PROPERTY LOCATION: ~rv6Ea Q~D
Name: (owner) fl.~a~sW N:-5, ~-1 G SUBDIVISION -T,a6i=,l Q'c~ LOT #
System Installer. Lr S~aocyPE. Registration #
Basement with plumbing. ❑ Garage X Number of Bedrooms _-3__-
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well ltb o feet
System Type: =G 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.
~rsiem uas veep mnatiev m compuance with
North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PFRMIT rnkInITIAMC•
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 Other tiC. (.AA N P-s Septic Tank: S ob o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ►6O feet ditches 3 feet ditches inches
French Drain Required: feet
Authorized State Agent (ZC.I3 Date 111301 0
Central Carolina Holding, LLC Ti,:k~~ts 40015205
1626 McKoy Town Road
Tima: 13:40127 14=02154
Cameron, NC 28326 ^ O
Gross:13380 LB N Out Manual Wt
Trucks LAIWSi ARP Tare v"] 92`0 LS M In Manual Wt
Cuss :,T,= xc 40,-)086/LARRY SHAPES SEPT Not: 214t30 LB
Truck Types Dump Truck
i4a`eri.als I Services {quantity Unit Rate Amount
..ter. r,rrr+.. a.rrr~r.wry.....,...t.«.....►r....+•....----r........-r--r«..- -----..r..--...-..--..__+..___..______.._...._
100% of L)RIZU2 inch DFH To 10.73 Tons $22.()O/'ion 4236.06
,Aa1 Amount: $236.06
Dri Ver ,
Deputy
Lifer ;'amrtOri
TNl -id of tare CGjcs is from the Fuef Grade location and meets the Nc speciHcou" ae
Sit; a ;ai a 4vnstevratet system approval IWWR•2002-CM 1W We cMP
k"dut" fos Rock Aypmgrah in WdkWW FIB.