OPHTE# `-7-s54►rcoc� Harnett County Department of Public Health 24593
PERMIT # -DLA 0 eration Permit
New Installation Se tic Tank X Nitrification Line El Repair El Expansion
PROPERTY LOCATION: c.t_v t as V.A
Name: (owner) E(pazGlta SUBDIVISION LOT # GS'
System Installer: 5,-)c> >.R Er Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: = 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.
[his system has been installed in compliance with applicable North Carolina General statutes, Rules for Sewage Treatment and Disposal, and all onditions of the Improvement Permit and (onstuction 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 ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
�k Other 1 ict.4- C�-.PS
Septic Tank: 1610 gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage field ditcher
of each ditch ab feet
ditches 3 feet
Irl
ditches ' s0 inches
French Drain Reauiredv---
n ar feet
Authorized State Agent ��� ��� � Date r- I ac I7
�7-5-y\oa
Central Carolina Holdings
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:
Libby Cameron
Driver:
Ticket: 1228592
Date:6/27/2017
Time:13:52:01 - 14:06:29
Scale
Gross: 43320 lb Out Manual Wt
Tare: 22160 lb In Manual Wt
Net: 21160 lb
Quantity Unit Rate/Unit Amount
-----------------------------------
10.58 TON $25.00/TN $264.50
Total Taxes: $18.51
Total Amount: $283.01
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