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OPATE #—� Aarnett County Department of Public Health 2353-5 PERMIT #.��11 0 eration Permit New Installation IS, Septic Tank Nitrifica 'on Line ❑ Repair ❑ Expansior PROPERTY LOCATION: Name: (owner) i L --w KJ SUBDIVISION LOT # System Installer: G%-Qf- EJ Registration # Basement with plumbing: ❑ Garage "kT Number of Bedrooms 3 Type of Water Supply: ❑ Community N Public ❑ Well Distance from well 100 feet System Type: 1 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. tms system has peen mstaheo in compuance with appucaoie north Larouna uenerat statutes, pules tot sewage treatment and Disposal, and all conditions of the Improvement Permit and Lonstructlon Authorization. PERMIT CONDITIONS: I. Performance: System shall perform in accordance with Rule .1961. Il. Monitoring: As required by Rule .1961. 111. Maintenance: As required by Rule .1961. Other: Subsurface system operator required? Yes ❑ Nol 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 sewage disposal s stem on the above captioned property. Type of system: El Conventional Other Subsurface No. of exact length Drainage Field `-ditchts, of each ditch -70 feet French Drain Required: _ Linear feet Alarm ❑ H2OLine ❑ PWR Line Septic Tank: ko b© gallons Pump Tank: gallons width of depth of ditches feet ditches inches Authorized State Agent - ~! �'A5 Date I'4„ A q oLk