IPACNEWX REPAIR ❑ EX NSION El
Type of Structure: Moo ~3O nr7 6'
Proposed Wastewater System Type: vr'-'iloN'3y
Projected Daily Flow: t-)"i O GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes ;S~ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well l®C1 feet
Permit conditions:
Permit valid for:
XFive years
❑ No expiration
Authorized State Agent::
The issuance of this permit by the Health Department in no way guarantees the ' nee
site is subject to revocation if the site plan, plat, or the intended use changes. The Imp
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Date: SEE ATTACHED SITE SKETCH
of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
ent Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
Construction Authorization
(Required for Building Permit)
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1951, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
with the attached system layout.
ISSUED TO: D ~O s Lt. ,aevt Y ` PROPERTY LOCATION: V, Q n COO r s2~7v~~, t-w~
SUBDIVISION LOT #
Facility Type: MOD New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System** ~°fb -pvc ~1 o r► ~y's Em (Initial) Wastewater Flow: DSO GPD
(See note below, if applicable
l)
purrle>a 1o -~vc S1~JQ (Repajr)
Installation Re uirements/Conditions Number of trenches a
Septic Tank Size f O ® gallons Exact length of each trench 150 feet Trench Spacing: _ Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: r- inches
Maximum Trench Depth of. W-ate inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM inches below pipe
p n Aggregate Depth: inches above pipe
Cc"ditions; s5~~ N c i a _ ~v -5 P~. yo-'o FGrU.y ~ Fs NIP p r„ F-0 inches total
II PS (INCLUDING IRRIGATION) MUST RE I OFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
M..-I'..ES ALLOWED IN INITIAL O REPAIR DRAIN FIELD AREA.
**If applicable: / understand the system type specified is different from the type specified on the application. / accept the specifications of this permit.
Owner/Legal Representative Date:
This Construction Authori ation is subject to revoc 'on i to pia , at, or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorization is c compliance with p s s and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: N-1 >®v j5 Date: L
Construe ' Authorization Expiration Date:
HTE# Permit # `A69
14(al-nett County )e tal-fille t of Public fle"(dth
Site ketch
ISSUED TO:
Authorized State Agent:
_ PROPERTY LOCATON: ~ (0y"4(ZkY\n, LM)
SUBDIVISION LOT #
T o a,`7 i
1 Ocv%y C
~J
30,
Department of Environment, Health and Natural Resources
Division of Environmental Health Sheet:
On-Site Wastewater Section Property ID:
Lot
SOIL/SITE EVALUATION File
for ON-SITE WASTE Code:
WATER SYSTEM
Owner: Applicant:
Address: Date Evaluated: 31~e'
Proposed Facility: Ly ice; f i6c) c- Design Flow(. 1949):
Location of Site: Property Size:
Property Recorded:
Water Supply: t~Public❑ Individual ❑ Well
Evaluation Method A er Boring ❑ Pit ❑ Sprang ❑ Other
Type of Wastewater: Sewage Cut
❑ Industrial Process ❑ Mixed
P
R
O
F SOIL MORPHOLOGY
I .1940 .1941 OTHER
L Landscape Horizon PROFILE FACTORS
E Position/ Depth .1941 .soil
# Sloe % .1941 Soil
p (h Structure/ Consistence Wetness/ Sa 13 Sapro
LS Texture Mineralo Color D th IN. Class
Class
Vpi'l
V Tf i.
0.5 k(-,
Description
Initial Re a' S stem
P Y
S s
Other Factors (.1946):
Available S ace .1945)
m
Site Classification (.1948):
S stem T e(s)
Site LTAR
~ttc Evaluated By: ~rj
)t Others Present:
.1944 Profile
Restr Class
Horiz & LTAR
1)