OPHTE# I (0-5-3,630 Harnett County Department of Public Health 24580
PERMIT # 99 a. Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: R,o
Name: (owner) Qta=, ` MCi�ti^Ja C ua a l.Q SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and A 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 Conmumon Authannuon.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 tl�above captioned property.
Type of system: El Conventional Other 1 a RB NJP 5 Septic Tank: gallons Pump Tank; gallons
SubsurfaceNo. of exact length width of depth of
Drainage Field ditches of each ditch s 3 feet ditches 3 feet ditches 3 o_a O inches
French Drain Required: Linear feet
Authorized State Agent fZ—ii5 Date
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 tl�above captioned property.
Type of system: El Conventional Other 1 a RB NJP 5 Septic Tank: gallons Pump Tank; gallons
SubsurfaceNo. of exact length width of depth of
Drainage Field ditches of each ditch s 3 feet ditches 3 feet ditches 3 o_a O inches
French Drain Required: Linear feet
Authorized State Agent fZ—ii5 Date
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Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Ticket: 1220063
Date:6/14/2017
Time:14:29:08 - 14:49:24
Scale
Gross: 42300 lb Out Manual Wt
Tare: 22100 lb In Manual Wt
Net: 20200 lb
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Origin Wastes & Sevices Quantity Unit Rate/Unit Amount
------------------------------------------------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material 10.10 TON $25.00/TN $252.50
Total Taxes: $17.67
Total Amount: $270.17
Weighmaster: Driver:
Libby Cameron
Fhts ioad of tiro chips is from the. Fuel Grade location and meets the No speeMloallorl a
vafive Wastewater system approval IWWS-2GWR3R for lire Chip
Satsiiiution for Rock AyyreRrafe in Nitrification Fields.