Laserfiche WebLink
Cornmerce.wi.gov County <br /> Safety and Buildings Division Dane <br /> ttisconsin 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(filled in by Co) <br /> Department of Commerce Madison,WI 53707-7162 13-2015-00131 <br /> Sanitary Permit Application State Transaction Number <br /> In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate <br /> governmental unit is required prior to obtaining a sanitary permit.Note:Application forms for state-owned Project Address(if different than mailing) <br /> POWTS are submitted to the Department of Commerce.Personal information you provide may be used for 2787 LALOR RD <br /> secondary purposes in accordance with the Privacy Law,s.15.04(IXm),Stats. <br /> L Application Information-Please Print All Information <br /> Property Owner's Name Parcel# <br /> TIMOTHY CURRAN 0610-072-9000-3 <br /> Property Owner's Mailing Address Property Location <br /> 8519 W 88TH TER <br /> Govt.Lot <br /> City,State Zip Code Phone Number SW '/4 NW 1/4 Section 7 <br /> OVERLAND PARK,KS 66212 (circle one) <br /> T 06 N. R 10 E <br /> IL Type of Building(check all that apply) Lot# <br /> O 1 or 2 Family Dwelling-Number of Bedrooms 3 Subdivision Name <br /> Block# <br /> ❑ Public/Commercial-Describe Use City/Village/Town of <br /> ❑ State Owned-Describe Use CSM Number TOWN OF DUNN <br /> III.Type of Permit:(Check only one box on line A.Complete line B if applicable) <br /> A. ❑ New System 0 Replacement System ❑ Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System(explain) <br /> List previous Permit Number and Date Issued <br /> B. ❑Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑ Permit Transfer to <br /> Before Expiration New Owner - <br /> IV.Type of POWTS System/Component/Device:(check all that apply) <br /> El Non-Pressurized In-Ground ❑Pressurized In-Ground ❑ At Grade ❑Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil <br /> ❑ Holding Tank ❑Other Dispersal Component: ❑Pretreatment device: <br /> V.Dispersal/I'reatment Area Information: <br /> Design Flow(gdp) Design Soil Application Rate(gpdsf) Dispersal Area Required(s0 Dispersal Area Proposed(sf) System Elevation <br /> 450 0.4 1125 1128 98.3',97.5'. <br /> VI.Tank Info Capacity in Total #of Manufacturer d <br /> Gallons Gallons Units e o d o <br /> New Tanks Existing Tanks <br /> o <br /> 0_12 c0> im i � LLt7 W <br /> a <br /> Septic or Holding Tank 1000 1000 1 Meade ✓ <br /> Dosing Chamber 650 650 1 Meade ✓ <br /> VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. <br /> Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number <br /> Andrew Meinholz Permit application completed online 220165 (608)831-8103 <br /> Plumber's Address(Street,City,State,Zip Code) <br /> 6813 County Highway K,Waunakee,WI 53597- <br /> VIII.County/Department Use Only <br /> Permit Fee Date Issued Issuing Agent Signature <br /> 0 Approved ODisapproved <br /> ❑Owner given reason for denial $431.00 05/12/2015 Richard Herro <br /> IX.Conditions of Approval/Reason for Disapproval <br /> Old house to be razed. <br /> Old septic tank and drainfield to be abandoned. <br /> New forcemain pipe must be at least 25 feet from existing well. <br /> Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size <br />