OPH T E # / -3 -s = �7,2s-70 Harnett County Department of Public Health 23079
PERMIT# Operation Permit
R! New Installation 12"'Septic Tank Ef Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2cl
Name: (owner) �i���r 1��d t�� SUBDIVISION LOT #
System Installer: G.® p= Registration #
Basement with plumbing: El Garage El Number of Bedrooms 2
Type of Water Supply: ❑ Community ❑ Public Z Well Distance from well /CQ feet
System Type: LTG— 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.
Ims system nas Been Instaneo In compliance Wlm appucao@ norm Larouna t7eneral statutes, Wes Tor )ewake Treatment and
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and all conditions of me Improvement rermlt and I.onstructlon Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No LZ
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 sewadisposal system on the above captioned property.
Type of system: ❑ Conventional Er Other 77,,-c C : nJ Septic Tank: 10 Q (4 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 7s_ feet ditches �_ feet ditches may' inches
French Drain Required: Linear feet
Authorized State Ager� l c�'° — ,,zcw// Date 1-2-
/j-J=3D -s�,v
Central Carolina Holdings
Ticket:
427862
Date
12/16/2013
Time10:10:19
- 10:27:25
Scale
Customer:
!0369650001'/ Larry= Sharpes
Gross: 45640
lb Out Manual
Wt
Tare: 22880
lb In Manual
Wt
Net: 22760
lb
Generator:
NA / Not Applicable
Dest:
DEST: CCH / Central Caroli
Truck:
'LARRY'SHAR'
Comment:
Origin
Wastes '& Sevices
Quantity Unit'
Rate /Unit
Amount
NA / Not.Applicable.
DFMT116 /Drain Fill
Material 11.38 TON
$22.00 /TN
$250.36'
Total Taxes:
$16.90
Total Amount:
$267.26
Weighma'ster:
giver:
Libby, Cameron
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