The URL can be used to link to this page

Home My WebLink AboutIMPV-5-11-17989.TIF Environmental Health Additional Fee Collection Notice � The following additional fees as checked below must be coliected prior to further action by our department � Repair Permit Application � Permit revision (re-draw) � I� Well Permit Cr Authorization to Construct (system upgrades, etc) � Other (please explain below) ' (� � , ^ /1��;��C �� R `S 'i EHS � . C� � ` �J Date �� f �� r �� "��}�� - �� ,,.q�C�r j} ��j �r ; . _--� � �-X15; ir�• -:`l�"��rf � �1'. d`Sua� � - �u'+�C��c� � : - � SI,� ,� �aW�i e�r �l d ��'� � l a 1 5 d11 �' �.1 � CQ h �ts �•; ,j ��'. S � � ! ' ' ' �' i S"c: �� i�� es i nq�S S�i � rt � r— q oo� iS �vo� �t�. � � � � � ��oo� lU+�-�-� � o I� -� � �o�rte� +�f l� as �Show�. � [� Yt� C,V T}ir � i�l(�I h, 4 r �, � Yt • • `J � � iI� It1 �16v aa� � c��Se��+. � ,� ��, �t � z�.. ��4� � � g � � � � i oY�v �i5�1'r� "��YS �v �2�a �_y��. ��Q � � }1 , ,�p;,��:re� �� pv�� • . 1 s , pr,� l v S S� � 1 ; ` � , r �V �'� � i P' U I�c..' �I C�Y I'�' ' (�Gi � � Y �-'. s S-�,�� M�s-� b� c��s� n�d b�h e� �n� �� y � � � � I � W q�� t , r , � 1 � ` n C� G� ��e�� cF, L�1 L�L'� ��lv�} � 3�K� , �¢4'� 1 re��A�YS �h�� L��'"�� U� �' S� r��-�v�gl r►� a"` �� .� � cc:,� ,YOm� � ��,�� r��c� �la�� .� � ., � r �l u5�% a �amM�h� w�` , � ��'� � l � � -__------- io ' � nY; �Si� 10' $'ne..� \� � Q � � -- zy �. -� - `_� , �, 1l� d �Y- .D .O _ �. `� ,�' a t� . � � � G �5 a .._ � � j � '''�" �� S � G.... aL V a.• �'� .:�- � x J � � � L'� ° `" ...}. Q � � AS � �1.. �" " �, ~ �2 d L' i G� ` 10 , �►�� I a�K � � �� '�' 15' I BQsL- I rw.kC�,�' , � r` �.. � `a\'� +' �� i}irnn� ��r �o ; 300 S . l. _` � �� 47, b1 ' 37• 3�' I G�` �h(�v 11�� I ''= ��' � DEPARTMENf OF ENVIRONMENT AND NATURAL RESOURCES Sheet _ oj_ DMSION OF ENVIRONMENTAL HEALTH PROPERTY iD #: ON�ITE WASTEWATER SECTION ' COUNTY: SOIL/SITE EVAI..ZJATION � s � �� " for ON-SI�'E WASTEWATEY2 SYS'g'�1VI � � OWNER: P fX.111 B Y APPLICATION DATE 5" � I P I' �� ADDRESS: DATE EVALUA D: 5 II PROPOSED FACILITY: 3 �� PRO O ED DESIGN FLQW (.1949): �� bLi PROPERTY SIZE: �- xP � LOCATION OF SITE: 2 ►' �C �r NL PR(�PERTY RECORDED: WATERStJPPLY: � Private � Puhlic � Well � Spring �.Other �D� ��,N�� EVALUATION METHOD: � Auger Boring � Pit � Cut T'YPE OF WASTEWATER: � Sewage � Industrial Process 0 Mixed :::P::E::� :::::::::::::::::::::::::: :::::�::::EE::i:i:ii:::[:::::::::::::�:��:::::::::::::::�:�:�:::'::::�iE::i:E:ii:E�::?:' �;:::::;:::::::i:iii:::::i�i:iii:EifiitEE::ti;i::ii:E:::Ei;:::::::::�::::::::::::::::::::::;:?:;:�:�::::iiii�E:�E� ::::::::: �--------------------------- --------------------- ------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ------------------------� ::: .:::::::�:::� ::::::::::::::::::: ::::::::::.�:--:::::.:::�::..:...::::�:::::..:..::��:�:�:�:�::��::�-:::�:�:::::::::::::::::::::::::::::::::::::: �::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::R ::: ::::::::::::::::.::::::::::: ::.::::::::E:i:::::,: :: � y. . . y�y�y�y. �.y �. : � :: . �r:.. �.:::::::::::::::::::;::::::::::::::: :::: . �. �.. r.�,+ b �:::::::::::::::::::::::::::::::::::::::::;:::::::,::::::::::::::::::::::::::: ::::::::::::::::::::::::: ::� �.:::::•:.:::�.:::::� ::::::::::::::::::::::::::::::::::��1L:��.R1LC:Zl��V�:::::::::::::::::::::::::::::�::::: �::::�1:Ll;ii �:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�:::: . . . ...::::::::::::::::�rS:::::::::::::::::::::::::::::::::::::::::::::��::::::'::::::':::::::::::::._. ......................... ::.. .::: :::::::::::::::::::::::::::: ::::::::::::::::::::: :::::::::::::::.::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ... . . . ......................... . . . . � . _ . . .. .: :: . :...�...: . . . .. . :::::'::::::::::i:::::::i::::::::::::::::::::::: ::::::::::::::::::::::::: :� ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�::::: :194'I :::..':::::::::::::::[::::: :::::::::::::::::::::::::::::::::�: . .:�..: • ::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::4...........�:::..:....................................................... ..PRb��:�',��'0�:::::�:::::::::::::::::::::::::::::::::::::::::: ::::::::�::::::::::::::; ::...... : .......................... ..................... ........................................................................................... .....................................................................................: ::�:�::::-.... ........................, :::� :::: :::::::::: � �:��::::::::: ::�::::::::s::::::::: :...:: : : :::::: : . : _........._ ._. ._... .. . .._... . .... . ...... . . ........................ :: .:::: ::::::::::i9.4U::::::::: ::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::�:::�::::::::: ::::::::::::::::::::::: ::::::::::::::::::::::: ::::::::::::::::.:::.:: ;:::::i::::::.:;:::�::�:�:: � ::: :::::::::::::::::::::::::::: ::::...........:::::: ::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::.:::::::::::::::::: ::::::::::: : ::::: ::::::::::::::::::::::: ::::::::::: ::::::::::: ::::::::::::::::::::::: ::::::::::::::::::::::::: :::...: :�:: .... ............:::•:::::::::::::�: :::: :::�:::� :::::::::::�::::::::::::::�:::::::::::::::::: ::,::::::.19.42::::::::: ::::::::::::::::::::::: .::::::::::::::::::::::. ::::::::::::::::::::::: ::::::::::::::::::::::::: ::: :::::::::[: :.. p»...:::.....H?E?f31 ::::::::::::::::: ��kl!! ............ ..................... ............:::::::�: ::�: :::::::::::::::::: .:::::::::•.::::::::::,.,._ ,::::::::::::::::: .:::::::::....;...:::::::::: ::::::::....,....,::::: :::::::::.:.:..: ::::::. :::::::: :�:: :•::::::: ::::::::::::::::::::::::: �:::: ......_ . ... ............:.....::::::: :::::: ::::: ::::::::::::::::::: : ........ ...... :::::::::::::::::: ::::::::::::::::::: : ::.:.::::::::::::� :::::�::: :::::::: :::::::;......:..:::::: �::::::�1356:::::: :::::::. .9. ::::::: ::_::.,..............,... :::::::....:::. .... ::::::::::::ZON::::::::::::::::::::::-� :::::: :::::: S?�XP� ::::::: :::..:............::: ::::::::. . . .. : .:. :::::::: ::::::.. .. ... . .. :.: : .. . .. .:::::: .:: .. : :::::: . :::::: ::::� :.,... .. .., ,.,PROFLI,�:: •.:::::::5"Y11tUG'��Yi�f .::::::::::::::CON�iS"L'E11tC�/:::::: ::WLTN,ES�E::::::::50� ::�A$CLU::: ::::�5'�'R::[:::::::.:..:.,:..::..::::: �:�;::: ::�QST.t`:I:Q:PiC:: :: DEp'T'H ::: :::::::::::::::::::::::::::: �:::::::::::::::: :: �::::::::::::::::::::::::::::::::.::::::::: :::..:. .:..:::. : :...... .... . ... ............ ..... ..... . . ::::::� :::::..............:::•::::::::::: :::::::::::::::::: :::::::::::::::::: ::::::: ::::: . AEPT ::::::::: :....:::............:............ : .: . �� . ..... ......:. .... . ..:: ::::�: ::: : � ::: :-:::: `i EXTU�i:::::::::::: ::::::: MINERALOGY::::::: :::::COLOR:::""::'............ 8::: :::: CLrI$5::::: ::: HQEZI7;::�: :;�: `:.,;.. .....,.::: :: :: :::$LOPT�' : . ..�r�...:.:... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�::::::::: :::::::::::::: :::::::: ::: ::::�::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::: ::::+&:LT,AR::: .................. ............................................. ....... ..... .. .... ....... . ..... ....... � I �� , C.L `-� -�� . :.` : Sf Y . 1 - ND _ _ �;. �.3� � ( 2 � ( 3 � 4 '� ia + tc air �,� ui':F DESCIUPTION 1NTITAL SYSTEM ttEenIIt sYS�M OTHER FACTORS (.1946): Available Space (.1945) c SITE CLASSIFICATION (.1948): nn �✓ EVALUATEDBY: NIFGiC!! �� + CVS�Y- ��:;,�+Ct,S SystemType(s) P O'THER(S) PRESENT: � Site LTAR D, 35 -+ �• ►7 COMMENTS: ��_�_. , S �� ,-� � �� ' P �, � � � � ��E� _` �'�` ,� �� :� - --,=- � � �1�t�� ._.----,-�-� ��r�;k _�._ _.., __•__, � � � �� '