OPHTE# IS-5'`��� Harnett County Department of Public Health 23758
PERMIT # Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: P 1 cCggb ,tc,,4
Name: (owner) eCoy SUBDIVISION 9F's NIri)Nrctr� LOT #
System Installer: LPCyL-V S>) wy F— Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well L 00' feet
System Type: LL r_ 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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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 ❑ Noe(
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑
Alarm ❑ H2O1-ine
❑
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional I Other 5 n Q.E CIA \P3
Septic Tank: 1000 gallons
Pump Tank
Subsurface
No. of exact length
width of
depth of
Drainage field
3 of each ditch 13S feet
ditches 3 feet
ditches IT
french Drain Required:
Linear feet
Authorized State Agent -N& QQ%5 Date
PWR Line
gallons
inches
0
1
Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Ticket: 828066
Date:9/25/2015
Time:10:53:28 - 11:07:12
Scale
Gross: 93600 lb Out Manual Wt
Tare: 22080 lb In Manual Wt
Net: 21520 lb
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Origin wastes & Sevices Quantity Unit Rate/Unit Amount
------------------------------------------------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material 10.76 TON $22.00/TN $236.72
Total Taxes: $16.57
Total Amount: $253.29
Weighmaster: Driver:
Libby Cameron
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