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, 02/18/98 16:16 NO.634 D02 <br /> • s <br /> . • DANE COUNTY 1202 Northport Drive <br /> ri f� ENVIRONMENTAL HEALTH DEPARTMENT Madison, Wisconsin 53704 <br /> • C2"` Phone•266-4953 <br /> PERMIT APPLICATION FOR PRIVATE DOMESTIC SEWAGE S9l';-•$TEMS <br /> A. LOCATION OF PREMISE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED . ' <br /> r <br /> LEGAL DESCRIPTION: Name One: <br /> Part of NW+ of NW 1, See. 3, CITY VILLAGE• <br /> TWNSP 8N Range 10E (TWN. Burke) Burke TOWNSHIP <br /> B. OWNER OF PROPERTY MAILING ADDRESS <br /> Name (Street City, Zip Code)1703 Reid Dr. <br /> John & Mary Strange Appleton, Wis . ,54911 <br /> 1 <br /> C. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION 2r REPLACEMENT ADDITION. <br /> MATERIALS: Prefab Concrete_ r Poured in Place Steel Other ;No. of Tanks 2 <br /> D. TYPE OF OCCUPANCY <br /> One or_Two Family Residence X No. of Bedrooms 3 <br /> Commercial x Industrial Other No.of Persons to be Accommodated 2 <br /> Kennet-30 dogs capacity (sp cify)e Leading; fp.ctor 0,5 <br /> E. APPLIANCES, ETC.: Food Waste Grinder X YES NO Automatic Clothes Washer X __YES NO <br /> House Dishwasher X YES NO Other (Specify) <br /> F. EFFLUENT DISPOSAL SYSTEM NEW_ A ,EXTENSION___...._ ADDITION REPLACEMENT, <br /> Seepage Trenches: No. 2p, Feet ^Z9nch Width. Depth Number of Lines, �c ;t <br /> Seepage Bed: Length.....-... Width. '' Depth ..- Tile Size '� No. Lines.'44 wow e <br /> Seepage Pit: Inside diameter Liquid Depth __ <br /> G. Percent of slope of land / .- 96 -46--.:S direction 40 <br /> -IcQ,,,,,,e j PERCOLATION TEST <br /> T Hours Water Test Time Drop In Water Level Inches Minutes <br /> Test Depth Character of Soil Since Hole in Hole Interval Second to ' Next t–p Last To Fall <br /> Number Inches Thickness in Inches 1st Wetted Overnight in Minutes Last Period Last Period Period One Inch <br /> Example <br /> P- 0 36" Top Soil 10", Clay 26" 25 yes or no 30 Ya Ili 'h 60 <br /> arc r . <br /> ►P (c/ T t ay A.A0 , /ar /z zo• <br /> ot fr fP ,, 4 07 y Aro 30 .2 / Jr <br /> 3 fr j ' ,r 1° 341 XV N* 30 14- - it 11; go <br /> RECORD DATA FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED <br /> S 0 I L B O R I N G S—Minimum 36" Below Proposed Absorption System - <br /> Boring Total Depth Depth to Ground Water Depth to Bedrock <br /> Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches <br /> Example __., <br /> B- 0 72" 72" _ Black Top Soil 12"; Clay 16" Sand 18'x;-Gravel 24" <br /> ■ ) ff0 )0' aOj ke / c 4/ .►ZD f - ,el -4 <br /> h rd ,f .fin,y- ,r ' „r I, so <br /> :C � d� ,1i. ii <br /> 3 81' I, f p, - if /V K 70 <br /> RECORD DATA FROM MINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED <br />