OP RHTE# M -~2, Harriett County Department of Public health 21335
PERMIT # ZS6~ {o Operation Permit
New Installation Septic Tank El Repair Nitrification Line El Expansion
PROPERTY LOCATION:
Name: (owner) GEoe-cE. vet,/~r~ ~r3~ SUBDIVISION LOT #
System Installer: , i w N arc Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 1*
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 50 feet
System Type: S? 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.
jilt) }rvem nay ueen umanea in
wun appncaole norm carouna general statutes, NO for )ewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization,
rt:ntin wtrvntM:
1. Performance: System shall perform in accordance with Rule .1961.
If. 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:
following are the specifications for the sewage disposal system on the above captioned roperty.
Type of system: ❑ Conventional Other QuM9-70 Gw w i6g;K~ v%c.,4. Septic Tank: tOOQ gallons Pump Tank: 1040 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 50 feet ditches 3 feet ditches 3C, 5 inches
French Drain Reauire \ faar
Authorized State Agent Date -5 J I-7110
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