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IPAC Rtype of Structure: Z:)1-U ' ' ' ' ` _T 3/ Proposed Wastewater System Type: 'p v(4 o ZOS r yycr,—Ng , Projected Daily Flow: y'-,(3 GPD Number of bedrooms: Li Number of Occupants: '0Q max Basement ❑Yes XNo Pump Required: JN�es ❑ No ❑ May be required based on final location and elevations of facilities Type of Water Supply: ❑ Community Public ❑ Well Distance from well ® feet Permit conditions: Authorized State Agent:: `� , �� Q4-10i The issuance of this permit by the Health Department in no way guarantees t i nce site is subject to revocation if the site plan, plat, or the intended use changes. The the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit.. Permit valid for: XFive years ❑ No expiration Date: ) I) b 11.3 SEE ATTACHED SITE SKETCH of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This k7ent 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: S�v vy �A 0trE5 PROPERTY LOCATION: ll SUBDIVISION 1�E,.sc.,a F's�C1.�,s LOT # 5-3 Facility Type: `-�Q `S ni ,3/ )< New ❑ Expansion ❑ Repair Basement? ❑ Yes ", No Basement Fixtures? ❑ Yes �KNo Type of Wastewater System ** 1Pu ch4 t 0>� (Initial) Wastewater Flow: GPD (See note below, if applicable ❑) _ h y *t-�4 ,Q c�-� fa R ZzJM S M (Repair) Installation Requirements /Conditions Number of trenches I Septic Tank Size i ® ® © gallons Exact length of each trench feet Pump Tank Size L ®® 0 gallons Trenches shall be installed on contour at a Maximum Trench Depth of: 1'*o inches (Trench bottoms shall be level to +/ -1/4" in all directions) Pump Requirements: ft. TDH vs. GPM Conditions: Trench Spacing: ni Feet on Center Soil Cover: inches (Maximum soil cover shall not exceed 36" above the trench bottom) Aggregate Depth: inches below pipe inches above pipe inches total * *If applicable: I understand the system type specified is different from the type specified on the app lication. / accept the specifications of this permit Owner /Legal Representative Signature: Date: This Construction Authorization is subject to revGGation if the site plan, plat, 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 sn igompliance with pr`oyts he — W Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH Authorized State Agent: E'L— S Date: 1 11- 13 Construe uthorization Expiration Date: 1 L HTE# Permit # H""'Nett County Department of Public Health Site Sketch PROPERTY LOCATON: ez ISSUED TO: SUBDIVISION -kS�LAN*j vzpctK -5 LOT Authorized State Agent: Q i15 I-F) Date: ) C� I "I3/ 11 1 H c or, L p �1 �, q-o pq-) -q C-- Department of Environment, Health and Natural Resources Division of Environmental Health On -Site Wastewater Section SOIL /SITE EVALUATION for ON -SITE WASTEWATER SYSTEM Owner: Applicant: Address: Date Evaluated: Proposed Facility: Design Flow (.1949): LVO ; Location of Site: Property Recorded: �' Water Supply: Public❑ Individual ❑ Well Evaluation Method: ®. Auger Boring ❑ Pit ❑ Cut Type of Wastewater: Sewage ❑ Industrial Process Sheet: Property ID: Lot #: File #: Code: Property Size: ❑ Spring ❑ Other ❑ Mixed P R O F I L E # .1940 Landscape Position/ Slope % Horizon Depth (In.) SOIL MORPHOLOGY .1941 OTHER PROFILE FACTORS Profile Class & LTAR .1941 Structure/ Texture .1941 Consistence Mineralogy .1942 Soil Wetness/ Color 1943 Soil Depth (IN .) .1956 Sapro Class .1944 Restr Horiz _ Ghi��i -�7 Cj� s �' -5 osbr? 1 P� 4 ' Description Initial Systerp Repair System Other Factors (.1946): Site Classification (.1948): \49 Evaluated By: r Others Present: —% Available Space (.1945) V System Type(s) �' U n r ".� Site LTAR Z 1�3- _