OP RHTE #��—
PERMIT # —7 '95-f
Name: (owner) I—B o Y &
System Installer:
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type: 4
(In accordance with Table V a)
This system has been installed in compliance with a
of Bedrooms
❑ Well
Types V aM VI
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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:
❑ D -Box ❑ Pump ❑
Following are the specifications for the seewwaggeerdisposal system on the above captioned property.
Type of system: El Conventional L�' Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 46 feet
French Drain Required: Linear feet
Alarm ❑
tems expire in 5 years.
monthsy rior to expiration for permit renewal.
� n�
all ditions f the Improvement Permit and Construction Authorization.
1-12O1-ine ❑
PWR Line
Septic Tank: `�'' ' gallons Pump Tank: gallons
width of depth of
ditches feet ditches 24 inches
Authorized State Date 1 —
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