OPHTE# t1-5- G-Ma Harnett County Department of Public Health
PERMIT # ~ora~ Operation Permit 2 2 41 2
New Installation X Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Po ~,oECz os c~
Name: (owner) SUBDIVISION LOT #
System Installer: 1_ V,ost. y -5 --QgC- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -Z-
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 feet
System Type: _ a Types V and VI Systems expire in 5 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 larolma beneral Statutes, Rules for Sewage Ireatment and Ulsposal, and all conditions of the
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rermlt and lonstructlon Authorization,
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PERMIT CONDITIONS:
1. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional \Q1 Other -T' LC- CAA '\9.2 Septic Tank: N 0 b Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches o ditch feet ditches feet ditches inches
French Drain Reauired: C~C~ Lin
Authorized State Agent V_0\1V Date
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Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CCH / Central Caroli
Truck: SNARPE
Comment :
Ticket: 1_05422
Date:7/23/2012
Time:12:32:26 - 12:57:52
Scale
Gross: 42360 lb Out Manual Wt
Tare: 22020 lb In Manual Wt
Net: 20340 lb
Origin Wastes & Sevices Quantity Unit Rate/Unit Amount
NA / Not Applicable DFMT116/Drain Fill Matarial 10.17 TON $22.00/TN $223.74
Total Taxes: $15.10
Total Amount: $238.84
Weighmaster: [)river:
Libby Cameron
TMs load of fire chips is from the Fuel Grade location and meets the Nc specification as
si(-- :n it:.;:n~thr Wastewater system approval IWWS-2002-03R for tire chip
Su~siiruilon for Rock Aggregrate In Nitrification Fields,