HomeMy WebLinkAboutOPHTE# Iu- - 335x.5- Hai .tt County Department of Pub1h. .health
233
PERMIT # 179g6 0 erati on Plerrmt
❑ New Installation
2rSeptic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ,y—/yy8A
Name: (owner) SUBDIVISION Z7 —f-P�5 LOT # 36
System Installer: 'Rvr tjf P"[ Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms -
Type of Water Supply: El Community Vpublic ❑ Well Distance from well feet
System Type: 25'IAE6 -�rC.t 4,/ rAir__ T�„-e .fir G' 421,0 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) c p,� r must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas oeen mstauea in compoance wim appucame norm Larmma uenerai xatutes, naves for )ewage ereatment ana uosposai, ana an cons¢ ions m me improvement rermtt ana Lonstrucnon Autnonzanon.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 13' Other 2"o tZ62V U-L,-z au 4-c- Septic Tank: � 0 ®V gallons Pump Tank: gallons
Subsurface No. of exact length I width of depth of
Drainage Field ditches of each ditch l Z—Z feet ditches 3 feet ditches Z---) tf� inches
french Drain Required: Linear feet
Authorized State A ent — i� ; /'Z1W Date i —?
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