HomeMy WebLinkAboutSUNDI LAKE BLK 2 LT 7A1_o1'
e, e~eoAz~t lo~ ~t ~pe~ults
f. Percolation Test performed by
Use the reverse side of this fo~m to show diaEram. Dia~ra~ should include
~he fol~owlng information: ~opePty linss~.well location, house location,
~p'tlc tank location~ disposal area location, location of pePeolation test~
~ direction of ground slope,
The ~]fo~.w~tlon on this form is true and correct to the best of my knowledge.
\ %~nature 'of Applicant Date Signed
T.~O BE FILLED OUT BY HEALTH DEPART~,~ENT PERSONNEL
~:he above described sanitary facilities are hereby approved, subje~ to the
........... ~611owing con~ons: .......
The above described sanitary facilities are disapproved for the following
reasons:
Signature of M.~'~i¢.fi',l.~ ~?'."~ 2~''' . '~te ::,"~. ~( :.~, ;~.
Approval is valid for one year following the date of approval.
CPJ: cw
INDIVIDUAL SENAGE AND WATER FACILITIES
( ~11 out in T~lDllcate)
5, Water, Analysis:
a. Bactar,~ al
b. Detepgent__
Well data:
b. Depth_
c. Casing S~ze
2.
3.
4.
5.
Distance from well to closest existing or proposed:
Sewer line
Septic tank__ 71 ~ ^
Property Line
~ ~ , ~/~houses, ba~n, d~ainage d~tch, etc. ~'
7~ 7~Se~e disposal system. ~,/,.~ _~_~"
~ ~ ~ ep~ic tank ~apaclty in g~lions
~/ C. Name of septic tank manufactu~e'm
~ 1. If "home made" show diagram on reverse side of this form.
1, Distance to property llne
to house foundation
· e, Percolation. Te'st 're sulks .....
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagra~ should include
3-~he foil.owing information: property lines~ .well location, house location,
v~IJt~c tank location, disposal area location, location of percolation test,
a~d direction of ground slope.
The ~n~t~on on this form is true and correct to the best of my knowledge.
S~gnature of Applicant
Date Signed
T__O BE FILLED OUT BY HEALTH DEPAPT~.~ENT PERSONNEL
e above escrlbed sanitary facilities are hereby approved, subject to the
........ ~6'llowing condi.~ions i
Conditions:
The above described sanitary facilities are disspproved for the following
reasons:
''Signature of ~fi's.f&t.g
" ,-' .,. Zate
Approval is valid for one year following the date of approval.
CPJ:cw