Revised OP repair area based on proposed pool see 13-5-30559 ET inspectionHTE# Hae.Iett County Department of Publk, Health
PERMIT # a619-1 Operation Permit 22321
New Installation '. Septic Tank 14 Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Qoc,s 94>
Name: (owner) MAA r. 1' omg—s LLC SUBDIVISION Ocku-oill . LOT # 1®
System Installer: GMA-4F<.. �p�c.�c. o C Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 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.
ims system nas peen instaueo to
with applicable North Carolina General statutes, nines Tor sewage treatment and
1`
4
1C3?�
VEftstw009 PLC
ano an conamons or me improvement rermTt and Construction Authorization.
rtkMn CUNUMUN):
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Vys,�
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned prope
Type of system: ❑ Conventional X Other G's,Q , �� Septic Tank: 1060 gallons Pump Tank: 10070 gallons
Subsurface -1fo -e exact length width of depth of
Drainage Field ditches of each ditch QAO feet ditches 3 feet ditches _LB;a� inches
French Drain Required. __ t
Authorized State Agent \ Date _6111