OPHTE# 10-5-asoo3 Harnett County Department of Public Health 23870
PERMIT # Operation Permit
New Installation �4 Septic Tank . I Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Lg;o 40bC*�� SUBDIVISION LOT #
System Installer: L P%!Dn � 5-A,>" E Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well Ppb feet
System Type: 'amu 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 Statures, Rules for sewage Treatment and Disposal, and all conditions of the Improvement Permit and Lonstrunlon Autnomanon
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PERMIT CONDITIONS:
1. Performance:
System shall perform in accordance with Rule .1961.
If. 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 sewage disposal system on the above captioned property.
Type of system: Elonventional IXOther II:: Ci�YPS
Septic Tank: s606 gallons
Pump Tank gallons
Subsurface
Drainage Field
No. exact length
ditches of each ditch Iba feet
width of
ditches_ feet
depth of
ditches _inches
French Drain Reauired:
w 'ear fee[
Authorized State Agent 1*25 Date
ul
Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY
Comment:
Origin Wastes & Sevices
-----------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material
Weighmaster:
Driver:
Elizabeth Nipper
Ticket: 880379
Date:12/16/2015
Time:14:42:41 - 14:43:23
Scale
Gross: 43420 lb Out Manual Wt
Tare: 22300 lb In Manual Wt
Net: 21120 lb
Quantity Unit Rate/Unit
---------------------------
10.56 TON $22.00/TN
Total Taxes:.
Total Amount:
-� eels the tic specification at
Grade Jacaiion and to 03R iot tite chip
the Fuel oval iY�Ws•20o2-
d of lite Chips is Ito the ,tem
slewolet sY' tion Fields.
1hoej In htncvaiive P tate in Nihifica
led -
subsitution tot Rock A99teg
Amount
$232.32
$16.27
$248.59