OPHTE# O `I ,� =�zgc;3 Harnett County Department of Public Health
PERMIT # �Sr� �'�' Operation Permit 22588
[_'New Installation Z' Septic Tank Z" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Tb /°' o -c-4, G-A.
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community C7' Public ❑ Well Distance from well feet
System Type: Z27(Z,' 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Rr Other Cklaf- Septic Tank: /G0' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /00 feet ditches J feet ditches inches
French Drain Required: Linear feet
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Authorized State Agen / (� `�—f w N� Date C- /i/4-Z
U9•�= 22- g G 3
Central Carolina
Holdings
Ticket:
295641
Date:5
/31/2013
Time:14:37:20
- 14:`55:08'
Scale
Customer:
0369650001
/ Larry Sharpes
Gross: 40920
lb Out Manual
Wt
Tare: 22060
lb In Manual
Wt
Net: 18860
lb
Generator.:
NA /
Not Applicable
Dest:'DEST
CCH / Central'Carolsi
Truck:
LARRY
SHAR
Comment
Origin
Wastes & Sevices
Quantity, Unit
Rate /Unit
Amount
NA / Not Applicable DFMT11:6 /Drain Fill
Material 9.43 TON`
$22!.00 /TN
$207.46
Total Taxes:
$14.00
Total Amount:
$221.46
Weighmaster
Driver:
Libby
Cameron
k