OPHTE# Harnett County Department of Public Health 23952
PERMIT At rsl8 g2ce Operation Permit
�ew -installation Tank Ergitrification Line ❑ Repair ❑ Expansion
(owner)
g , c>, ' / PROPERTY LOCATION: L e L.� .&b
Name: owner erea. SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms :3
Type of Water Supply: ❑ Community f'Public ❑ Well Distance from well feet
System Type: a Types V and VI Systems expire in S 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
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
K�Pl l
IV \
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the se7—, waar�disposal system own .e above captioned property.
Type of system: ❑ Conventional 2 OtherrC— l.h.�,v� Septic Tank UU U gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch /C)y feet ditches 3 feet ditches /S-aZtl inches
French Drain Required: Linear feet
Authorized State Ago i�f Date
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Central Carolina Holdings Ticket: 932507
Date:3/15/2016
--�'' Time.:14:54:27 - 15:19:55
Scale
Customer: 0369650001 / Larry Sharpes Gross: 44760 lb Out Manual Wt
Tare: 21820 lb In Manual Wt
Net: 22940 lb
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAP
Comment:
Origin Wastes & Sevices Quantity Unit Rate/Unit Amount
------------------------------------------------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material 11.47 TON $22.00/TN $252.34
Total Taxes: $17.67
Total Amount: $270.01
Weighmaster: Driver:
Libby Cameron
r
This load of lire chips is from the Fuel Grade location and meets the Nc specification as
gated in Innovative Wastewater system approval IWWS-2002.03R for tiro chip
.Substitution for Rock Aggrograto In Nitrification Fields.