HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 8
~ ~a~ .of person requesting approval
~. Nu~er of bedrooms in house .~
5. Wate~ Analysis:
b. Detergent
b Depth
~f~r~ ~3 3. Seepage Area
5. Property Line
Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainaEe ditch, etc. .
7e
Sewage disposal system.
a.
b.
c.
Age of
Septic tank capacity in gallons,
~Name of septic tank manufactu~
1. If "home made" show diagram on reverse side of this fo.rm.
d.' Disposal field or seepage pit size and ty~ ~'- ~
- 1. Distance to property li~e'~]~J to house foundation ~
e, Percolati~Test~esults
f. Percolation Test performed by ,. ,
Use the reverse .side of this form to show diagram. Diagram should include
-The followzng ~nformation: pwoperty lines;.well location, house location,
~ptle tank location, disposal area location, location of percolation test,
m~ direction of ~round slope.
The h~£or~rmtion on this form is true and correct t~..+~e best of my knowledge.
S~ature of AppIicant Date Si~ned
TO BE FILLED OUT BY HEALTH DEPART~.IENT PERSONNEL
~he above described sanitary facilities are hereby ~pproved, subje.~t to the
~llowin~ condi~on~! ,
Conditions: ~/~ ,,
The above described sanitary facilities are disapproved for the following
reasons:
Approval is valid for one year following the date of approval.
CPJ:cw
NOV !;~ ':' °
~, AXa~ka
B~t't~e D. Ada~, S~
~agioaal Sani~a~tem ~'viees
Divt~ieea af ~ Heal'~
be axpe~ed to f~met~m ~att~f~ ~ the
follo~n~ described praperty=