OPHTE#1-7-5-4It"n l Harnett County Department of Public Health 24613
PERMIT # 2L"153'6 Operation Permit
New Installation -IR Septic Tank �X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: (A- jQ_c» qc)
Name: (owner) L —1 Nvesey PnA.a+a. SUBDIVISION LOT #
System Installer: L NQA; r 5"PaRE Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community �( Public 11 Well Distance from well feet
System Type: _1 1_ 5_ 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.
Ibis 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above optioned property.
Type of system: ❑ Conventional � Other a ca G C� 4 PS
Subsurface No. of exact length
Drainage Field ditches 1-1 of each ditch s a O feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: LC!O ° gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches t $ inches
French Drain Req Linear feet
Date
Authorized State Agent Ya )1
V"
Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Ticket: 1250991
Date:7/31/2017
Time:15:36:13 - 15:36:54
Scale
Gross: 40420 lb Out Manual Wt.
Tare: 21760 lb In Manual Wt
Net: 18660 lb
Comment: - - -
Origin Wastes & Sevices Quantity Unit Rate/Unit Amount.
---------------------------- -------------
NA / Not Applicable DFMT116/Drain Fill Material 9.33 TON $25.00/TN $233.25
Total Taxes: $16.33
Total Amount: $249.58 -
Weighmaster: Driver: -
Libby Cameron - -
This load of tire chips is from the Fuel Grade location and meets the Ne specification as
elated In !nnovativs Wastewater system approval IWWS-2002.03R for tire chip
S"Ifution lot Rock Apgre0rate in Nitrification Fields.