OPAarnett County Department of Public Aealth 23273
PERMIT # Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ?5 550
Name: (owner) SUBDIVISION ® LOT # ►
System Installer: Vic) C P'1" -AC L- Registration #
Basement with plumbing: ❑ Garage ' Number of Bedrooms L4
Type of Water Supply: ❑ Community °',� Public ❑ Well Distance from well 1-00 feet
System Type: 5 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.
Ims system nas been mstauea in compuance wan appncanle norm tarmma aenerat statutes, nines for sewage Treatment ana
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 cc
IV. Operation:
V. Other:
0
ana all conaltlons of me Improvement rermlt ana Construction Authorization.
% �C r'a+► -1 t
1-70US�
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maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
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Type of system: El Conventional X Other Ouu 4 '�o C-iaP.tt�R ��('.1'�� Septic Tank: 10 Q) 0 gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch �� 0 feet ditches feet ditches ��-34 inches
French Drain Required: Linear feet
Authorized State Agent w6• ��% Date ,
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