OPHTE#\5—S= W06 Harnett County Department of Public Health 23823
PERMIT # S2-' Operation Permit
New Installation :K Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: E 94>
Name: (owner) �EPm�ac,� (�,y�y SUBDIVISION LOT #
System Installer: L.Plcun,,- S1a zs?E Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well VbCJ feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table Y 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 @e Improvement Permit and Construction Authorization
5F0
16
j � Hav3Z
1 Poor.
Az6P _
� R
`QQ1(L
i
PERMIT CONDITIONS
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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑
Pump ❑
Alarm ❑ H201-ine
❑ PWR Line
Following are the
specifications for the sewage disposal
system on the above captioned
property.
Type of system:
El Conventional X Other
11Q% �YisPS
Septic Tank: 1 COO gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch I al0
feet ditches _ 3 feet
ditches inches
French Drain Required
�� iwar feet
Authorized State Agent Bb>'J Date N t
IS -5-396T
Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Ticket: 856323
Date:11/6/2015
Time:14:42:16 - 15:00:29
Scale
Gross: 42740 lb. Out Manual Wt
Tare: 22360 lb In Manual Wt
Net: 20380 lb
Origin ,Wastes & Sevices Quantity Unit Rate/Unit Amount
------------------------------------------------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material 10.19. TON. .$22.00/TN $224.18
Total Taxes: $15.69
Total Amount: $239.87
Weighmaster:
Libby Cameron
r
Driver:
This load cf i4? c:1 1= a s;:n Ifld Fuel Smde 3o Ca" or. and 11"eefeth0 iiieation at
elated In Innovative Wastewale+ System approval IWWS-2002-03R to( the chy "-
SYbstfllWloo for Roek ARyreprats In Nlkilleation Fields.