HomeMy WebLinkAboutSeptic New 1448 Ellington Road / ifi' c Y�' CaFz d F4a' # a`¢ttr Y"` Y' •-'e. ,'` 'pff' '®'r' :�a,r{ "u�
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Application for Permit to Install or Repair dual Sev�age Iaa "System �; yIN
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>+ee Paid $: ...:'14:40...::. By .':�--�� . ..... ... �,Y,. �}
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Pursuap�t_to written a,Polxcation, permission i ltere}�y e to:. the Liceps �{ ► Layer named h
f for"repeat,, or eQn'st } 1on of an individual sewag EoS&v systemrr which the folldwf `
ijgo nation 1S submittz, x t " y � } y
4ocatl$Yn af,FPPeay "� 4...> 1.:1. &1_kt1s�ad 'Owner
- �Zt .3-:of Ovner Mc( i11 Adds , Q
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3:�e bft+SFSfV7.LFlF: } 11RfR•'��R.�'^^^iY.................................... ........ ..
(Dwelling, roi 1 n
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Nuniber..ofFersons o Occupy Premises e ..B k
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fi 8. A;vrage lei 1 �, i.
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T, , Manufacturer and y,
Liz uic Qa#a .heio dank Material of.Septic Tank d gu
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p o11, pnd�Sso }'{ i 1G° ti 'go r..`;c
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x Maximum ground water table. ... ....... .... .
If not se Y P supply:
rued, b ublic water su 1 w k }
co-from Owner's well ........... 4
From'atjacent wells ....................... .... ...
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} 10. Distance to nearest water course, drainage ditch, storm"' xSi�p ctr ,cnbaxdCne�x �r.r. ......... ....
:.Percolation Tests: Time:'for 1" drop in soil test
Classification of soil ...................v.. j.
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,r l2 Minimum square feet of effective seepage area required ' 1 .t
lS: .Leaching. System: Number of trenches . Ltan ?f f .. Width ... ..3.R.0..:.f .
Total Other .......................... ......
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14. Plot Plan Attached. ....NA ......................
15. 1{ tit Approved.
16. This permit expires 3:.. !ll�lb4�'.,:::1.E�'�2.;.. �4'
' SignatureAI
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Litt .I ► {I,i�srited Dr:. ayer)W9-20675 f,
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Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinance >,
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Pollution Problem abated Date ...............................
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