OP RHTE # .1 (1 — ',:-- 33 01!�) Z Aarnett County Department of Public Health 23508
PERMIT
VNew
on Permit
Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION5Lm-5— Aq-g�,je.#
Name: (owner) ,3Z C -Z;jG. SUBDIVISION LOT LOT #
System Installer: d/hZs1,. Registration #
Basement with plumbing: ❑ Garage Z- umber of Bedrooms 3
Type of Water Supply: El Community L�f Public ❑ Well Distance from well feet
System Type: ZS" T ZT' G 1;� es V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact eaki Department 6 months prior to expiration for permit renewal.
rcum wiwiiiva3;
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the sewax disposal 9stem on the above captioned property.
Type of system: El Conventional Other Z�l%/} VU"tvt� Septic Tank: DO ® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches �_ of each ditch -SOD feet ditches feet ditches Z'1 1,0 IW4ches
French Drain Required: Linear feet
Authorized State Date 3 — ! v — 15'
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