HomeMy WebLinkAboutBIRCHWOOD PARK BLK F LT 9010-
' ~. Name or person requesting app . a . , . .............
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2. "N~e' of pTopePty: owne~,, ~~/~ ~F~~A
a. Bact~rial~,
b. Detergent ...............
We].l dar a:
c. Casing Size ,,,
Distance from well to closest existing or propo~
1. Sewer line ..
2. Septic tank ....
3. Seepage Area .
Cesspool'.
5, Property Line...__.__,
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
b. Septic tank capacity in gallons.. ....
c. Name of septic tank manufac'tum~r .
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to property, line
to house foundation.
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