OPHTE#n-5-4zz'-�.4 Harnett County Department of Public Health 25021
PERMIT # a�%,i n Operation Permit
] New Installation �K Septic Tank �1< Nitrification Line ElRepair ElExpansion
PROPERTY LOCATION: Gs4-cwa,%sT rir
Name: (owner) —TGG iia. xcFnOU tt f --LG SUBDIVISION LOT #
System Installer. L—P%!! L� Syig4QrG Registration #
Basement with plumbing: ❑ Garage Ta Number of Bedrooms L
Type of Water Supply: ❑ Commune 'Nt Public ❑ Well Distance from well feet
System Type: S�. Types V and VI Systems expire in S years.
(In accordance with Table V a) J Owner must contact Health Department 6 months prior to expiration for permit renewal.
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PtNMII CUNDIIIUN):
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 the above captioned property.
Type of system: ❑ Conventional >( Other —rsca6 CA� v P3 Septic Tank: 10 C o gallons Pump Tank: gallons
Subsurface No. of exactlength width of depth of
Drainage Field2. of each ditch 100 feet ditches .�_ feet ditches 1 inches
French Drain Required Linear feet
Authorized State A¢ent \\. \ WLS Date z) �,v
Wp
,vat „• � ,,.
Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Ticket: 1381147
Date:2/26/2018
Time:09:42:24 - 09:51:49
Scale
Gross: 38480 LBS Out Manual Wt
Tare: 22480 LBS In Manual Wt
Net: 16000 LBS
Origin Wastes & Sevices Quantity Unit Rate/Unit Amount
------------------------------------------------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material 8.00 TON $25.00/TN $200.00
Total Taxes: $14.00
Total Amount: $214.00
Driver:
Deputy Weighmaster:
Libby Cameron
slaixe INS n Of the chips
Is tewat e Fuel r1fo( , E JV a`�jv4wS 2092-03R to m99h` the Nie hipficalion as
Substitution for Rock A99f9g1Qle in Nihificaiion fields.