OPHTE# I1-6-gacyHarnett County Department of Public Health 24854
PERMIT#ODuation Permit SS€ptic lan�
ew Installation Ik 0 --Rt[ fication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 19 c-4sW Pool Gi. 6t?, t "Lte,^ OvA
Name: (owner) "v 6*bc�ta, (arts SUBDIVISION 1pe"K LOT#
System Installer: (—C rr�j sti.�ee Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 2-fu—bric ❑ Well Distance from well 4 feet
System Type: C onvi. s;, 6,6. 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.
11. Monitoring: As required by Rule .1961.
111. 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: ❑ Conventionalf
& '�� Ghia,s i��
Septic Tank: +Oc-O
gallons Pump Tank: gallons
Subsurface No. of
exact length r—
width of
depth of
Drainage Field ditches
of each ditch l OCi
feet ditches
3 feet ditches /rli-lea inches
French Drain Reouired:
Linear feet
Authorized State Arent Lam' / /r irlyrF1'S Date
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,4101
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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
Driver:
0
Ticket: 1335268
Date:12/6/2017
Time:14:09:24 - 14:29:00
Scale
Gross: 45460 LBS Out Manual Wt
Tare: 22240 LBS In Manual Wt
Net: 23220 LBS
Quantity Unit Rate/Unit Amount
-----------------------------------
11.61 TON $25.00/TN $290.25
1Ulal ♦aXCJ: yc.v ..i..
Total Amount: $310.57
Deputy Weighmaster:
iza etNipper
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Dips is tram the Fuel Grade location and meets the NC spec!tieailon as
stc „ „� ;•;c-1-tewc;1er SYstem aDproval IWWS-2002-03R for tire chip
Suha:i:an•,::orRoa; a05fe9rate in Nitrification Fields.