HomeMy WebLinkAboutISTS Permit
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APPLICATION FOR INDIVIqUAL S~W AGE TREATMENT SYSTEM (ISTS) PERMIT
(Note to Applicanj,: only fin out shaded se~tion below)
TWP/(lity ~ . '6-F ,t.. J-.. '
Pro~Address /t '\ ;7(/, L'CLf-a.:-" ~ E'
Citjkip ;It.. "-" .'~ .(A' / '-..- .
Silt J;!valuator ~ ~.... , Installer
septic Tank Size as per -design submitted and approved / &;nt":!
_ Pump Tank Size as per design submitted and approved
""'Drainfield Size as per design submitted and approved (below)
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Date Received' ., / ~ I ()-<.
Permit # -13 - fl-p>"
Receipt # .,?.f; 1.7 )tt
Fee 7 so. rd
Receipt Code ('b L
New ISTS Replacement]l'
Percolation Rates ~. .;;z.<(, .51>
Number of Potential B~drooms "'"
Depth to Restricting Layer ---.t..s::
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i' ,i Arethere any wetHmds on property?
Wetland Replacement Plan allliched
Recommend: . Approval
Yes
Yes
Disapproval
No
No
Will any wetlands be impacted by proposed project? Yes No
LGU Exemption # Please attach copy of exemption.
Signature of Township ~r City Clerk
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Date
.-- COUNTY USE ONLY
ISTS Setbacks: Building (tanks) ~ (drainfield)~ Lot Lines (10') or ROW/Easement Lake/CreeklWetland Wells %
Approved i Denied By Scott County Environmental Health, subject to existing regulations and the following conditions:
1. Verify aJd maintain all rtquired setbackS and elevations.
2. Proted (fence offJ the primary and alternate drainfield locations while any building construction activity is occurring
on the site and, maintain fencing or some other approved barrier if the drainfield could be damaged after installation.
3. Install rock bed on contour and maintain at least 36 inches between the rock bed and the water table/mottling.
4. Protectsewer lines and system from freezing.
S. Divert surface water away from or around the drainfield area.
6. Sod or seed the area as soon as possible upon completion to prevent soil erosion and damage to the drainfield (for late
season installations, hay OI'straw can be substituted until sodding or seeding can be 1I0ne in the spring).
, 7. This permit is valid for 12 months from the date issued.
8. The property owner (or applicant, if different from the property owner) is responsible for assuring that the Installer
receives a copy oCtIle final Department approved design.
9. Nonresidential ISTS shall include a water meter and, if a dosing device'is used, an electrical event counter.
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[!: Signature 1W. 0 c"nll CLuJ---
Date~/d3/'l-
White - County Yellow - Township Pink - Applicant Gold - Township
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