OP RKE# 1 tt— 5- v t 5,�q g_ Ha2tt County Department of Publ' Health 23525
PERMIT # Operation Permit
New Installation ❑ Septic Tank )5� Nitrification Line ❑ Repair Expansion
PROPERTY LOCATION:
Name: (owner) Y— -- CI) N, t-NNnG SUBDIVISION LOT #
System Installer: (>v,� Nsy-c-,,\ c—'\, -a. ,AD Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community �K Public ❑ Well Distance from well to Q 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.
tnis system nas been instanea in compbance wan appucabie nortn tarouna uenerae matures, Wes for sewage treatment ana uisposai, ana au conamons or the improvement rermit ana Lonstrurnon sutnonzanon.
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PERMIT CONDITIONS:
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 l
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
13 "1OU [ ,51\�'G
D"\A'� -'D
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for the sewage disposal
s stem on the above captioned property. �^
�1 &131
Type of system: El
Conventional V Other
2 oW Septic Tank: tv c—
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditc es
of each ditch 15 feet ditches 3
feet ditches inches
French Drain Reauired:
ear feet
Authorized State Agent Date I �
I 1 . Y' - . a