OPHTE# 15-5-363/ Harnett County Department of Public Health 23834
PERMIT # a`�5= Operation Permit
New Installation "I Septic Tank )K Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: 'f`lEa spoo\E5 L+
Name: (owner) �ooea QaQs� SUBDIVISION WCz-,.e000 LOT # '7
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a
Type of Water Supply: ❑ Community '. Public ❑ Well Distance from well t O 0 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.
IAN system has been inslalnd m Compliance with applicable North Larolina General Statute; Rules for sewage Irealment and Disposal, and all conditions of the Improvement Perron and LonslmUlon Authnmatmn.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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:
Other: No )Done_ 0w S,tr_ Pr 'Crt a-_ O� \•x5 w1A�ro
❑ 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 Other1 , Q.E. x)95 Septic Tank: f00gallons Pump Tank: gallons
Subsurface No. of xact length width of depth of
Drainage Field ditchesq of each ditch SO feet ditches 3 feet ditches o1a'1 inches
French Drain Reauired:. ' Lin t
Authorized State Agent 'ala� SY--t15 Date 0
15-5-3533 )
Central Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Ticket: 866301
Date:11/23/2015
Time:15:55:31 - 16:13:37
Scale
Gross: 43740 lb Out Manual Wt
Tare: 21860 lb In Manual Wt
Net: 21880 lb
Generator: NA / Not Applicable
Dest: DEST:CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Origin. Wastes & Sevices Quantity Unit Rate/Unit - Amount
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NA / Not Applicable DFMT116/Drain Fill Material 10.94 TON $22.00/TN $240.68
Total Taxes: $16.8.5
Total Amount: $257.53
Weighmaster: Driver:
Libby Cameron
This toad of fire chips Is from the Furl Grade location and meets the No specification a$
stated in Innavative Wasiewalrr system approval IWWS-2002.03R for Rre chip
Substitution for Rock Aggregrate In Nitrification Fleldp.