WQ0041745_NC DOT Pump and Haul Permit_20200615

Attn: Christopher J. Steele, PLS
NCDOT Division 9 Right of Way
336-760-8737 Office
[e-mail]
1605 West Brook Plaza Drive, Suite 201
Winston-Salem, NC 27103
Pump and Haul Reimbursement Cover Letter
C204124 Macy Grove Rd Extension
TIP: U-4737
W BS: 36600.3.1
Parcel 36 Hayworth -Miller Funeral Home
Removal Dates: 3-2-20; 3-17-20; 4-1-20; 4-9-20; 5-4-20; 5-22-20
Removal Times: Varied times due to Funeral Services
Total Invoice Amount: $2,700.00
Pumping Contractor: Transou's Septic Service
Receiving Treatment Facility: Hayworth Miller Funeral Home - Kernersville
Approximate Volume of Wastewater Removed:
Comments:
*Please attach all invoices to this sheet.
See Invoices
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MAR/10/2020/TUG 09:21 AM FAX No,
P, 001/001
TRANSOU'S FORSYTH SEPTIC TANK
P.O. BOX 1.443
CLEMMONS N.C. 27012
BILL TO
HAYWORTH MILLER FUNERAL HOME
4192 CLEMMONS RD.4 375
CLEMMONS N.C. 27012 P.O. NO,
Invoice
DATD INVOICE #
3/5/2020 22434
TERMS I DUE DATE
Due on receipt 1 3/5/2020
DATE
DESCRIPTION
PROJECT LOCATION
AMOUNT
3/2/2020
PUMPING SFPTIC TANK -- PUh4PING 2
K-VILLE
450.00
TANKS FOR D.O.T,
0.00
We appreciate your prompt payment.
Total s450.00

MAR/27/2020/FR1 09:15 AM FAX No,
P. 001/001
TRANSOU'S FORSYTH SEPTIC TANK
P.O. BON 1443
CLEN MONS N.C. 27012
BILL TO
HA.YWORTH MILLER FUNERAL HOME
4182 CLEMMONS RD.# 375
CLEMMONS N.C. 27012 P.O. NO.
Invoice
DATE INVOICE #
3/23/2020 22539
TERMS DUE DATE
Due on receipt 3/23/2020
DATE
DESCRIPTION
PROJECTLOCATION
AMOUNT
3/17/2020
PUMPINCr SEPTIC TANK -- PUMPED 2
K-VILLE
450.00
TANKS FOR D.O.T.
0.00
We appreciate your prompt payment.
Total $450.00

APR/09/2020/THU 08:15 AM FAX No,
P, 001/001
TRANSOU'S FORSYTH SEPTIC TANK
P.O. BOX 1443
CLEMMONS N.C. 27012
BILL TO
14AYWORTH MILLER FUNERAL HOME
4182 CLEMMONS RD4 375
CLEMMONS N,C. 27012 P.O. NO,
Invoice
DATE INVOICE #
4/6/2020 22585
TERMS I DUE DATE
Due on receipt 1 4/6/2020
DATE
DESCRIPTION
PROJECT LOCATION
AMOUNT
4/1/2020
PUMPING SEPTIC TANK --
K-V1LLE
175.00
0.00
We appreciate your prompt payment.
Total $175.00

APR/22/2020/WED 07:33 AM FAX No,
P, 001/001
TRANSOU'S FORSYTH SEPTIC TANK
P.O. SOX 1443
CLEMMONS N.C. 27012
BILL TO
HAYWORTH MILLER FUNERAL HOME
4182 CLEMMONS RD.# 375
CLEMMONS N.C. 27012 P.O. NO.
Invoice
DATE INVOICE #
4/17/2020 22630
TERMS DUE DATE
Due on receipt 1 4/17/2020
DATE
DESCRIPTION
PROJECT LOCATION
AMOUNT
4/9/2020
PUMPING SEPTIC TANK -- PUMPED 2
K-VILLE
450.00
TANKS FOR D.O.T.
0.00
We appreciate your prompt payment.
Total $450.00

MAY/15/2020/FRI 08:32 AM FAX No,
P. 001/001
T]2ANSOU'S FORSYTH SEPTIC TANK
P.O. BOX 1443
CLEMMONS N.C. 27012
BILL TO
HAYWORTH MILLER FUNERAL HOME
4132 CLEMMONS RD.# 375
CLEMMONS N.C. 27012 P.O. NO.
Invoice
DATE INVOICE#
5/11/2020 22735
TERMS DUE DATE
Due on receipt 5/11/2020
DATE
DESCRIPTION
PROJECT LOCATION
AMOUNT
5/4/2020
PUMPING SEPTIC TANK =-- PUMPED 2
K-VILLE
450.00
TANKS FOR DOT
0.00
We appreciate your prompt payment.
Total $450.00

JUN/11/2020/THU 09:14 AM FAX No.
P, 001/002
TRANSOU'S FORSYTH SEPTIC TANK
P.O. BOX 1443
CLEMMONS N.C. 27012
BILL TO
HAYWORTH MILLER FUNERAL HOME
4182 CLEMMONS RD.# 375
CLEMMONS N.C. 27012 P.O. NO.
Invoice
DATE INVOICE #
6/8/2020 22849
TERMS I DUE DATE
Due on receipt 1 6/8/2020
DATE
DESCRIPTION
PROJECT LOCATION
AMOUNT
5/22/2020
PUMPINO SEPTIC TANK -- PUMPED
K-VILLE
450.00
2TANKS FOR DOT
0.00
We appreciate your prompt payment.
Total $450.00