TOWNSHIP Seaton t Sawn py ENVIRONMENTAL SERVICES (952 sss ap te ee APPLICATION FOR INDIVIDUAL ete meee et | oat i SEWAGE TREATMENT SYSTEM PERMIT iusecoazracmnun | “OOHE PropertyOwner Rawontor ‘Ext opsien: Buyer(lfprop.transfer)__—— Ph Sasa © tam rats Prelct Addie Sreseatn | oSieteny emer |e Townships Section Other Address DESIGN FLOW: DVariance (attached) Number of Bedrooms (octog tue and ptt betcons) Garbage disposal: Yes [No Type home (LIV) Bsmt. Sewage pump: [y Yes [I No Other (commercial, indus receatonal use) Whirpoot¥acuzzitub: ©) Yes [No Estimated dail flow (gallons per day) : Indoor plumbing changes required? ‘0 yes Ono rat ay Proposed soll treatment area marked/protected? © yes. O no ODesgnar ‘OSoler ‘Alternate soll treatment area available? © yes 0 no Olinstaler 0 Buyer ‘Owner informed of primary and alternate sol treatment area locations? © yes O no *, TANKS: ‘Approximate depth to tank cover:______ | SETBACKS: (Minimum identified in parentheses) J Seplc tank (galons) O New 0 Existing? Buiing to tank (102) ‘Pump tank (gallons) ) ‘gpm Building to sci treatment area (20 f.) Pump size (tp fthead | _Property boundary (10) Holding tank (gators —atarm | Road right-ofway (10) ‘Aerobic lank Wellcasing depth] Shalow Well “Pumping Certificate required i using esting tank = _Welto proposed sot treatment system (60 or 100 f.) Neighboring wos to sol teatment system (50 or 100 f) ‘SOIL TREATMENT AREA: == Wallto buried sewer tine (60 )* ‘0 Standard system: Trenches OAt-grade _O Mound Well to septictholding/pump tank (60 ft) ‘Other system: ____ Soll Sz. Factor ‘Welt to sump pump basket (201) ‘Weter ne (10 .)* Depih of System ____ Depth to Motting “Selbacks may bo reduced i ar-sestod Cisibuton medium: O Rock 0 Graveless Chamber {nches of rock below pipe. ‘Shoreland area? Oyes 0 no Lake Classification Reduction —__%, using "in. rock beneath pipe | Welhead protection area? Oyes. Ono ‘Soil Color at Treatment Depth______j___j___ | Floodplain area? Oyes O no ‘Square Ft. treatment area ta Fi, | Wetlana (75H) Oyes Ono Percent siope___% Percyata_____O-estimated _} Water bodies (60-200 f, depending on classification) Soils Map Unit____Suit ‘nero oartiy wih my signature os the Desiyner, that ll dee for this invidvel sewage tectment system design plan end oer required specications ere ve and ‘arc fo the ast of my knowlege. ‘Sinatire ‘Tense number Dae ‘Nae (Please Prini) “arose Daytime phone