OP RHTE# I P 5'35�� - Harnett County Department of Public Health 24561
PERMIT # '�`bq�1Z OOperation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION: N jeIC6tLLt.S LN
Name: (owner) L 15 Aby Ge,m e2,,3 N SUBDIVISION LOT #
System Installer: 1--wcwa f SNva2G Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: t— Types V and VI Systems expire in S 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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PERMIT CONDITIONS
I. 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 ❑ H2O1-ine ElPWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other —is (1E \PS Septic Tank: 10bo gallons Pump Tank: gallons
SubsurDrainage
Nora ez each
length width of 2 depth of
Drainage Field ditches of each ditch S.5 S fee[ ditches j feet ditches �-Ll inches
French Drain Reouired I eet
Authorized State Agent 7 � --"Zk y6n1 Date
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Central Carolina Holdings
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Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Origin Wastes & Sevices
-----------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material
Weighmaster:
Driver:
Libby Cameron
r
Ticket: 1216444
Date:6/8/2017
Time:15:24:07 - 15:51:03
Scale
Gross: 39960 lb Out Manual Wt
Tare: 22120 lb In Manual Wt
Net: 17840 lb
Quantity Unit Rate/Unit Amount
-----------------------------------
8.92 TON $25.00/TN $223.00
Total Taxes: $15.61
Total Amount: $238.61
This load of fire chips Is from the Fuel Grade location and meets the Nc specification as
stated in Innovative Wastewater system approvcl IWWS•2002-03R for tire chip
Substitution for Rock Aggregrate in Nihlftcation Fields.