HomeMy WebLinkAboutT15N R2W SEC 25 N.200' E165' Lot 14
REQUEST FOR APPROVAL OF /
INDIVIDUAL SEWAGE AND NATER FACILITIES
(Fill our in T~iplicate)
~a~ of erson re ues~in a moval --fO ~ &~ ~,~
b. Dete~ent .....
d, Distance ~o~ well to closest existin~ o~ p~opose~
1. 8ewe~ llne
2. Septic tank /~ /
.~ 3. Seepage Apea ,/d ~ /~,
5. P~opem~y Line /~ /~ .
6. Othem souPces of poss~le contamination, i,e.~ creeks~ lakes,
houses~ baPn~ dPainage ditch, etc. ~ ,.
b. Septic tank capacity in gallons, ~ ~ ,
c. Name of septic tank manufactB~e~ ~~
1. If "home made" show diagmam on revemse side of this form.
Disposal field or seepage pit size and type~
1, Distance to proper~cy, line ~3 IW_ to house darien
e, Perool~tlo~ Te~ ~esults
f. Pemcolation Tesz performed by
se the ~everse ,side of this forum to show diagram. Diagram shou~d inc~qde
.
he ~ollowing info~mation: propemty linea;.well location, house locatlon,
'~%~ptic tank location, disposa~ amea location, location of percolation tes~
a~, direction of ground slope.
9, The l~f-or~ation on ~his form is true and coDPec~ to the best of my knowledge.
'Signature of' Applicant
"' D'ate Si~ned
TO BE FILLED OUT BY HEALTH DEPART!4ENT PERSONNEL
~'he above described sanitary facilities are hereby approved, .s.ubject to the
......... ~l~owing conditions:
Conditions:
The above described sanitary facilities are disapproved for the following
Approval is valid for one year ~ollowlng the date of approval.
~ CPJ:cw
July 20, 1970
P.O. Box 1399
S~JECT: 5ewer al~l ~'ator
Facilities for tlo~e-. N 200',
E 165' of Lot 14. Sec. 25,
~S15N, R21¥, S.H~ Bir~wo~
Loop Aroa, ~roy Botts, ~r
At the r~quost of ~Ir. Lo~oy Botts, mt iusl~ction uas u~a~ of
thc s~,'or and ~ater facilities for the s~ject
~at~r is supplied by a 79' drilled ~ell uhi~ ~ts this ~-
par~nt~s approval. A ,ater s~-~le t~en {ro~ this ~;ell was
satisfactort.
~o so, er system coisists of' a log ~sspool 102' fro~, the
septic tank ~;my ~ i~atatlod bot~een tho h~ and fl~e existing
Up~ installation o~ the septic tank~ m~other tnSl~cti.on o~ the
so~er system ~ilt bo scheduled.
CLIFF~fl) P. JUI)~IN~
cc.* Lotoy Botts
Zrauda Realty
Sanitarian