Laserfiche WebLink
--- 1 ENVI 3' Cify� �'.+W. — <br /> • <br /> i ' . .t.. r-, n, I.-f /9 <br /> 9 <br /> - pr.B67 I) s�, State and Count 'o AJ.-a ,9,8 State Permit# ° 6l a <br /> fl&rl. Permit Application b 00,17110 County Permit#1 9-5151 for Private Domestic Sewage Systems ry n;‘?e,. County 1)19N E <br /> 'DENOTES STATE APPROVAL REQUIRED <br /> Date Approval Received from State if Required State Plan I.D. # <br /> A. OWNER OF PROPERTY l,, ,, Mailing Address: <br /> 41-_O Ma rP°� `"" 40-7--s Ni/�o.✓ 2a A/ <br /> B. L ATION: /V '/s '/a, Section eR q, T N, E (or) W Lot# 5! City <br /> Subdivision Name, nearest road, lake or landmark Blk# Village <br /> ___412_841 ! 41 /40 1. 'k' _(J Township kir1st&L <br /> C. TYPE OF OCCUPANCY: 'Commercial Industrial `Other (specify) `Variance <br /> Single family (/ Duplex No. of Bedrooms 3 No. of Persons 3 <br /> D. TYPE OF APPLIANCES: Dishwasher YES Vico Food Waste Grinder YES LNb' # of Bathrooms---3 <br /> Automatic Washer s!YES NO Other (specify) <br /> E. SEPTIC TANK CAPACITY /0 O O Total gallons No. of tanks / <br /> `Holding tank capacity Total gallons No. of tanks / <br /> New Installation Addition Replacement t/ Prefab Concrete /� <br /> 'Poured in Place Steel Other (specify) <br /> F. EFFLUENT DISPOSAL SYSTEM: Percolati9p-Rate 1)j7 2) ye 3) 31 Total Absorb Area //e6` sq. ft. <br /> New Addition Replacement � 'Fill System <br /> Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches <br /> Seepage Bed: Length '/7'Width 2 9' Depth V-V1Tile Depth 4 3l No. of Lines y <br /> • <br /> Seepage Pit: Inside diameter Liquid Depth Tile Size Y <br /> Percent:slope of land y7t Distance from critical slope d - <br /> t <br /> I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, <br /> Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared <br /> by the Certified Soil Tester,,p d <br /> NAME r1 .1 nt e!s- I L n L/A7 C.S.T. # 7jT and other information <br /> obtained from / (owner/builder). <br /> 1' <br /> Plumber's Signature P/MPRS1311-' s6 r' Phone #W's90 <br /> Plumber's Address P. Q. 47 .Sa.we error ire i, ..<j•fy p <br /> PLAN VIEW: Provide sketch below of system (include direccti 9 f slope and all distances in accord with <br /> --- 4 TO Al <br /> - T ' <br /> ' I ',- <br /> S �p /1 + <br /> $fi t- 1 , Aar ,- t I <br /> -- t- - <br /> i- --- -} t _ _ Pew <br /> + '11_ >�o .ol <br /> 1 <br /> f + , F :_ <br /> I J � ; 1 I 1�' ra/� Y <br /> __i I t } +-- -j T i ter! ;� 1- i- 'I'- -�_ �Q r',L , <br /> , �1; I S 1 <br /> L i r <br /> f t 1 #41.Qt ' , ; -+ ! <br /> I I. ' � �-1 ' l I I l i I 1 <br /> i <br /> a_ _ 1. _ <br /> i t f j1 ' l� <br /> - - 1 .. -IO.�t yucH T <br /> t Y. <br /> !.1-0-0-4-- i <br /> , ,sI � '�',, 1—� I i/0i. c I 1 I <br /> _- T <br /> 1'--` --1 1--- -- a^u it f <br /> , <br /> T l <br /> j 1- l i +_ - , i - <br /> 1 -' l- t r * --I , i T , 1: <br />