OPHTE# Harnett County Department of Public Health 2 0 8 6 7
PERMIT # al_ Operation Permit
X New Installation X Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1-\ wy
Name: (owner) CL--wE ~ATi~,gC3,a SUBDIVISION L~$ LOT # I:t-
System Installer: M CZ-P'j, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well X00 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.
)r>t~ill IIN ueell nmaleu in
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DCRMIT rnlunlTMILIC
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and all conditions of the Improvement Permit and Construction Authorization.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1 IQ-. - C-.lP Septic Tank: IMO gallons Pump Tank: gallons
Subsurface No. of exact length S width of depth of
Drainage Field ditches of each ditch d feet ditches feet ditches c`~:~ -36 inches
French Drain Reauired: in I apt
with appucame North Carolina Woeral Statutes, Rules for Sewage Treatment and
Authorized State Agent 'N-, ~c~g Date
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TRAILER OUT.
TRAILER IN:
Central Carolina Holdings, LLC
1616 McKoy Town Road
Camergn, N.C. 28326
919-499-2301
Fax: 919-499-4619
NC Watts: 1-800-232-0035
i
CUSTOMER s~ Date
This load of flse chips is hom the fuel/ Grads locaflon ond.mssts the Nc spoe tcaN= M
ADDRESS ,,,%12 1 1ow.at0i sYirflm approval IW ftufor Nis ctiip Time
Uvifuii;~n for Rock Agipe9fate in NBimcaflon FWds.
Dr', e
Passenger Car Tires #
Tractor Trailer Tires #
Farm Tractor Tires #
Other
PER LOAD ~Weight Empty
Weight Loaded
Total Tonnage of Tires , Customer Signature
H ° Terms: Net 15th Following Statement
WHITE COPY - OFFICE CANARY COPY - FILE PINK COPY - OFFICE GOLD COPY - CUSTOMER
CCTD DBA B.T. Sanitation, Inc.