OPHTE# r3- 5_3C Harnett County Department of Public Health
PERMIT # a1° ��� Operation Permit 22850
New Installation X ,Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
& PROPERTY LOCATION: I.- -cayQE N,i�
Name: (owner) �.t~T z.�.�G —��-� ° �''�`�: �4,�SUBDIVISION LOT #
System Installer: LK!g. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well Cam® feet
System Type: 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERM11 CUNDIIIUNS:
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: SYV—' CV'C\ L-0 64� a-s 0.0 1 Ay 6 F_ ?Q QQ-4W Q;, 09, '1 0 `',.S-T OL:"K510.1
❑ 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 1 1%F_ tiP5 Septic Tank: 1 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field - kdms_. of each ditch t Ste% feet ditches feet ditches a'l- inches
French Drain Reauirelktk, ~' Linear feet
Authorized State kent 12.6m Date -7
13 - 5 - 51%
Central Carolina'Holdin(
Customer:- 0369650001',
Generator: NA / Not Apj
Dest: DEST CCH /
Truck: LARRY SHAR
Comment:
Origin
NA / Not Applicable
1
i
Ticket:
301292
Date :6
/10/2013
Time:13:3'0:45
!- 13:46:20
Scale
warry Sharpes
Gross: 42820
lb Out Manual
Wt
Tare: 22200'
lb In Manual
Wt
Net: 20620'
lb
cable
antral Caroli
Wastes & Sevices
Quantity Unit`
Rate /Unit
Amount
DFMT116 /Drain Fill
Material 10.31 TON
$22`.00 /TN -
$226.82
Total Taxes:
$15.31
Total Amount:
$242.13
Driver: