OPHTE#C)% Harney, County Department of Public 9,,,ith 21 4 9 5
PERMIT # -7 Operation Permit
J New Installation -T9, Septic Tank ❑ Repair Nitrification Line El Expansion
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PROPERTY LOCATION: STO~,~c~w,cco
Name: (owner) ~Pv5or4 $G ~ay~., - SUBDIVISION LOT #
System Installer: ANr,,Gr vEcw Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l0 d 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.
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 ❑ N O~K
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 property.
Type of system: ❑ Conventional Other EZ FLOW Septic Tank: 146 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch \0C) feet ditches 3 feet ditches inches
French Drain Reouired: ~ , \ ti.. >t:f
Authorized State Agent_ Rjpk Date GI 1d I0
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