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016-637-30-2103-SAN-2022-253 '�� ' Indu�tn Scr�ice�l)irision , C�,unt�� � i � �822�9ad��on 1'ard���a� � � � � � �� ���� � M3di5on. W'I J370J Sanitap�Pcrmit Vumhcr to be�illcd in b� C_��1 � � � P.O. (30� 7162 �p -- - -- � a,`�f `%�' i Madison. �'JI �;707-7162 �p 3� 02 3 O � � — �- - -- -- � Sanitary Permit Application ' �`°`` '�a"'`„``""�'"",h`� � ln accordancc���ith SPS 383 21(21. Wis.,�dnt Codc,suhmission of this form to thc apprupriat�Qovernmcntal uni[ � �� '� � �8'� � � (J� is requircd prior to obtaining a Sanilan�pennit �v'ote: .�pplication forms(i�r siatc-o�cned PC)V���I�S are subn�iticd to Pr�jcct:1d�ln•ss!if�ik��n mailing address � the Departmcnt ol�Safct� and Pn,l��sional Scn�ices 1'er;�m�31 inti�nnati�,n�ou procide mu��hc used t�x,econda�� � purposcs in uccordancc�cith lhc Pi�i�ac� La�c.� 1�_U 1(I)I m)_Stats � � �u�� �� 1.Apptication tnformation-Please PrintAli tnformation � � ���� Pr��p�rtc O��ner�s Vamc Parcel� � ,�� � / ,(] , • --r��-��rL-1`Y�.S_ ��C _ - - -- . �I b - � 3 7 - 3 0 - 2�b 3 � Propert�O�cncr s Mailin�;�ddre5s � � Propertc Location � ^^ J --- 9�a � -- % :� �e�_��---- - �� y ou ��� ;h Cil�_Statc lip Codc I Phunc Numhcr � �- J�� / LI�_'�-( I�1-�'- Sccticm �O �= L qn �� 83� i.71�-�-/►�-��7� lI.Type vf Building(ch ck al!that appiy) �.ot� �� ti� fz�� �� C�I or 2 Pamih�D�ccllm��-NumbcrofBcdniom�___yJ _---- � Subdicitiion'�'ame — � ___ 131ock•"- ❑ Public;Commereial--Describc t ,e -------- -___ ___-_ -- -- •_� _ _--- _� ❑Cit��of - ---- --- ----_ ❑State O�a�ned-Describe lise � ----- s-�'— � CSN1Numbcr i ❑ Villagcoi� - - , -------_ -- - - - ���I�o��n of ��4�G Z.0���o II(.Tr�pe of POWTS Permit:(Check either"`'ew"or"Replacement"and otlaer appiicable on line a. Check one box on line B.Complete line C if a licabie. ! I� -- r— -- _- — Ne��� Sy�stem �� Replacement S}�stem I_� Other Modification to E�isun�System(explainl ❑ Additional Pretrcatment Unil(esplain) B. � - ❑ Holdine I ank ❑ In=Ground ��At-Grade ❑ Mound ❑ Individual Site Desi�n ❑ Other"l�ype(cxplain) (c�nventional) � ��, ;� � �� , l ist Precious Pcm�it tiumbcr and[�atc!ssucd � Rene�cal f3eibre . , Rrcision � _� Change ul(lumbcr � ❑ l�rans(er tu tie�c O�cner�-� f[�piration � � IV.DispersallTreatment Area and Tank Infnrmation: Design Flo�c(gpd) Desian Soil Application Ratc(gpd/s� Dispenal Area Rcquircd(s� Dispers�l;�rea Proposcd�s� Svstem ElecaLioii y� -- - ' � " o ' _ q�.75'�,���-s � Capa�ih�in l�otal n of '�lanulacturer � �� �I�anl� In�i�rm�i�inn Gallons Gallons Units �� � ; � I � � ) J I J i � I .- NewTanks CsislmgTank. � � � -� _ i � � � � � - I - -- ---- �, , v� � r I = �. � ^_. I i S� hc ur iol iin�Taok � �� I � - �-���` �- �- �-�- --- ---�- �-- 1--- i,�.in;_ hmnhei � �/ I - n - ---}- - -- � I V.Respon5ibility Stafement- l,fhe undersigned,ussurnc responsibility for'nsts�liation of the YC1t�l;5 sl��yhe attached plans. Plumber s tiamc(Printl Plu 'er�s i�naturr -- - ��\� \1P1 �\umh�r �13u��nc"I'h�,n�humhcr _1 � ! _ ��-�lG�-- a - - — — - — -----���7_� :11_�-���{�$�� �li mber�s,lddress(Strcet. it�.�tate.7ip 'ide) i i . � i i � VI.C un (Departre�enf lrse �ly � � y T---- ( � - -- --�---j Permit Fec �)utc Is�ucJ I� cin���\���nt`ii�_nature � ;A rot� � ❑ Di,appr�,ccd (,/ � -- - ��'� " � ❑Uwner(iiven Keason fbr Denial � 1�� .� � ���S�oZo� I �i�2''v�'"�"�"'�/(/v.� ('onditione ot�Appro��aliR�a��ms ior Disappro�al .} %/� /'� o `�� ��n��\\ ,�`��;—_.,�-, �P C'._ 1 f '� O�-��.�-�-...�...,..:.._ � j L'._J X� l4� �3��r '1 �' ", /` '� V � c h�.: �N�s 5 E P 1 4 Z 0 2 z _��_��..��_..___ C ST �-2-- � � ( �cpt#�le,� w�r,�� ��3K� SAINYER COUNTY ZONING ADMaN�STRATIOI�M _lttach tn complete plans fur thes�ctem and cubmit to the Coun�c unh�on paper not less than 8�:2 c I I inches in�ize ����� Si3[�—�39x rrt. 03!2>> NO RCFUNDS AFTER ISSUE OF PEfitJltT ` �•\�i2 7 1 I�1�' Vdisu�nsin Depar�ment vf Safery.md Professional ticrvices �!�, � Phone 60R?66-�I1� Diviti�on uf In�uslry ti����iccs � �,f F��'� Ar� ��Eb.hllp://dsps wi�uv 1X_"�1a�isou Yards V�a}� '' `"� Lmail d5�v�"a-wi,���tisin.,�ov PO Box 7302 � �� �� �����j � �" 1 . ntodi�on.wi�3�0� Tony Evcrs,Governor ;��;;;�__ Dun Hereth,Secretar�• _�s,u;�*, �- September 12, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-09-12 Plan Review: PWTS-092202183-C CandrtlattaJty CLARENCE L GLOTFELTY APP(��VED N4955 Sunny Hill Rd n��g.c�F sA���ry as�a P�oF�ssior��,� Weyerhaeuser WI 54895 �=R��`wE� r,�tstr�I.a�eN�3U�TRv s�RVI<:�S SITE: � Hidden Acres Dairy �{����t o..--=-�-�, $�-�N Lund Road ____----___—. _._—.____---__---. I own of'1�v.d�w��'a�;�� ���c��Rfs�Q����c� Sawyer County P.O. NE, NW, S30, T37N, R6W Total Amount: $250.00 FOR: Description: Three Bedroom At-grade System \Sloping site At-Grade Component Manual - Version 3.0 (May 2�22-2027), 450 GPD, 40" depth to limiting factor, Maintenance required, Effluent filter, New construction The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20{2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copv o(the approved plans specifications and this letter shall be ornsile durinq construction and open to inspection bv authorized representatives of the Department which mav include local insoectors. Owner Responsibilities . The current owner,and each subseyuent owner,shall receive a copy of this letter.Owners shall also receive a copy of the appropriate operation and maintenance manual(s)and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapler and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the continyency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance lracking purposes. Reports shall Ce submitted at intervals appropriate for the component(s)utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance:.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries conceming this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for lhe installation,operation or maintenance of the POWTS. Sincerely, ���"�� Gerard M Swim POWTS Plan Reviewer WI DSPS-Division of Industry Services (608)789-7892—voice ',err ,s�,vim��.'v,.�,vi,c,;�_;v - x- - � t IVT'IAL A��'�G�AC�E �3�S1GN Fre�suriz�t! - Sl,��z€►�g 5ir� tt���X A6�I� �`ITLE �F�EET Proj�ct Hid�en /�cre�� Dairy At-Grade co„�rtt�,pafly APPRtJVED Own��� i-liciilerl �cres Dairy a���'. c�� sn����t ar�o ��oF�ssio�,a� _�___--- — s��zv�c�s c�iv�sir�r� oF �r�e�us���s�.az��ic�s �dciress ��2� ttit IV��,��ira� F2d. � {,�L���L'G�/� {�,..�L-t-,,—'_--"�, Exela€�d. WI 54t�3� ��- - s�� coR�Es��r�a�rac� hone: 7��-4��`,�« 2�72 Leg�! Descriptic�ri i.�.������''�� i � ���� ��������,�.����/�.=`��`_�� Town�hi�+ � � � cjJ uJ broo k rounty SawYer _._�__. S�ib�l6v��ic�r� C�Jarrt� ��-- - Lot �to. ���--�-�-�- Parcel ID Numb�r a'� �? (�,�, ' �j',�.:. �:`� --���` Plan Transactian IVumb�r It��#e� �heet Page 1 C;aicuiations F'age 2 �t-gr�c�e drawinc�s Page 3 L��t�r�is ar�d dos� tar�� Page �I ���e€�i���tions Pa�e � hlfan�g�.rnent & corrtir�gency plan F'age 6 ..�� ��.5t"'Vc�_ �v.��.� ._�� �_ ���� �> L7esigner Clarence Glotfeity Lice��se Number 22072� < < � � � � Signature � , � � � � � Nun�l��r 7'1�;��G�-S�33�9 _� D�te (7 !18/2� Designed �ursEiant Et�: At-r�r�dE� Cc�m��rment ivlan�ial Ver. 2.0 for I��O11V1 S SE3C?-1 fl854-P {N 031(l7}, and both SSWMP PublicaEion J.E DEs€yr� c�f Pressur�z C�sstributit�n hletuvar}cs f�r S i - S�t� ��118�i) anct P���s�ure €�istrit��_itic�� t��am�c�n�rai �fE�n��f i���>��_ 2_0 SBC� 9�77�3C3-P (N. J�,'�l1} Version �.0 t03/12) �'�ge 1 of � �� �s�J�i��C� �`T-G��4DE D�SIGN �.�-�r����l��i�r�ttYt�r�Csheei ��ia�aing Si�� Flows and Site Rata �ntry. (r�r c) � _��--�€�esieie��tia( er cor�tmercial? __ 300,Q��str�t�t�r� wast�vvater flc?w{g��� _��t�f�.0 C�+��ic�� �r��t�water flow(�Pd1 _�.._.._ 3Afl % Site sE�pe _ __._.___ 95.7�!�orlts���r el�v. b�low lat�ral (ft� _�E__4�.�����p�9� t�:irr�iting faetor(ii�} �.�___..� O�CA�En-si�� sc�il�pplicatior� rat�{gpdfft^2) �istribut�can �ell i�forrra�tiiea� {� c�r�2) -��.�..�� lnflu�nt�,astewater c�ca�lify �......._.�__ ,__.�._.__ `�_5Q{ Lin��r E��clir�g�-���gpolft� ? _____ 7,�Qk �"ff�:cii�i��aorp�i�n wic�th {ftj '.�0 Cv1ax r�¢ferti�F�vvidth ��rn�i#tec9 (ft) __��t00.U�? �1q��r-L�c�.xt� ��n��th (ft) � Pressure Distributiara L?�ta �n�ry {c C�r�e} �_.___. __�] �er�ter�r er�� later�l conn�ctic�r� �___.__� Nur�?ber af idf�r�is 0,1�6; c�rifice di��rieter(inj �_� 0.25 rv�t�r�n�� __�_.__.._. �.�0� Estim����c��rifice� �cin �ft� r.�alcid.tion m.�_.____._ .___.�,� F� g , ) �.5t?; Fc�r��main diar�net�r(in} __ 4.87 f=orc�mait� flev4+v�locity (ffisec) 42,�0? F�rce�'nain length (ft) ��or n �r � Daes forcemai��drain back? �___._�_. ___.. S� 5�3� P��rr;��ank�lev�ts�n (fC; ,��or r i --y � �re lat�r�ls�t tiigl��st pflint�� � ,� `,y�t�rn h��c3 (ft) x 1.:� ! � Np — 5-i� Ve r�ir��l lif��tt} 3.9 Forc�main drair�back �g�15 2 68 �ric;i�}r E�s��ft1 45.Q ax Lat�ral void voEu�ne �.t�aij ���Q, In-lir�e��i����Loss (ftj ��.� t��inimum do�e v�lume(gal) � 13.�4� Ts���� �yn�r�i�he�d (ft} 26_8 Sys9�em de�manc6 (�p�-n) � k.���ra!D��rra�t�r��:����f�c�� Gal{onstlr��h Calcula�csr i�f;t�i_�n�E) F`ipe cJiameter L�:;i��r cpf=�ns b sign choice ��Q��Otc�� ��ftk �� �Cit e'�� ��� �_...___._� 6� }� �� � i��sit�n�r � ir� _� m_____ ' ' 46 -i�otai INor�in� �iq�rid [�ep�P� (in) ___. rr�t�s���Eec;� �� 2s I� � � 16.3 Ga(!in (enfer re�ult in ce�l �4�) �� cn�(a��r�E _.1 5 i„ � � __��__� �i�r�,�t�r �;n � f Treatrnent Tank In#r�rEn�tis��o _.__._..__.__ , -_�....; r_..._...._. ���;�, �� ! � '�25p(Sept�c tank ua�acit}� (9a�) _._ _�___ �_�.___.__.�...____, �____ �H saf#c utt__.__--_____�€�'1�a n�a f�c�d�r�r �fflllQ(lk�IIteC I91�L�I'E73��t[St2 Dose T'ank fnforrr�atiari �. --_ Bs�t �Filt�r mar.ufar��i�re� 750 0 [�as�tank ca�a�;it}�i�al� �GF-94 'Filter n��elei num��r 16.3�Dose tank val��rne ( alti�r ' ____... _.�_____ .__..,._,. ..._�_.� ._�..__________r.�_. 9 ) t-fufFcutt ��anufaetu�er � Project: Hi�cie-n lacr�s Dairy �-C�r�d� '� Transaction �umbe;; F��e 2 e�f� � AT-GRA[�E P�,AId �IEW � �o ---t � �''-� 1iC 6 C}t�servatic�n pipe�(2 typicaf� �, A (.50 ft' � 1 a �fla oo ft �+�---� �i� � �6.c7 ft � - � C 9.50 ft � C D 5 00 ft � '�" '-`�"' " � �� E 2.00 ft � � � L 110�70 ft � W 19.50 ft ��� �___ �� A x B 75Q.00 ft^2 �_ _ � t- ____— _-_� d. �--.___- Cap � =Total a r� ate c�li A x C3 TYpical o��.pipe. �'� �� `� Slc�ttecl in the lower G",and (�"—"-1 anchor€�cJ secur�ly. l._. J ` f'��Vved ar�� � x�+'V � �„ � AT-GRACtE ��Q�S �ECTI�}1'+I Svnthetic fabric cc�v�er �-� � �''A � � � g7 54 ft Finished grade / �' ���y `� � s�`�`��' elevation l.aferai � `� �. �� invsrt elev. �.25 ft �,; �. ,' �,r - " : �F - �bservation pip� ,.� :,. . �� ��`�� I at ac�gregate to� •�; �'� E � � %;'�,. Surfaee cor7touf _ - `�,� �'' 3 % Slope and system �5.75 fk ~�`A",_-----___ f �_� 1-`•,,,,_� elevatior� `��--��� —T � �\. = 12 i�_ tcpscail and ��abs�l \ '� "," over aggrec�at� a�ci t�p�red to to�s. �Piowed lay�r below L x W [T�_i = t� in. �ggr�gate b�low piPe(s), and � in. above �ipe. Prc�ject Hidden,�c��es D�iry At-�rad� Trai�sactic�n Number Pac�e `� �f �' PF�����R� E�I�TRl��T9t�N ANQ QOS� TANK �.atera! Dia�eaoa� - C��a��r Cc�nneetion ��:,�...� ,.,�.�.._. ��� _�_�. .�...�..�, .�� ..�� ,a�'�.._ ,.�,�..n _..�.�., � ��„�,. ..� �._..,,.� a.,... � ...,....,�,..�. �..,.�,.._.w.._.�,�.. �..�....�_ � ����ale-Fr,������^s�. . . f.�t�fal�E�;�s.'��t"i�\iTta�sC�t�°Vf a,.h�s' !_��€E�!`!��IYt,!i��;����i�r��i�.��R # + �r v F�.:�T�h;���fiC�� F�ti7F>:�r�lir�.��ri€tj��c�t�s�tr�e�E c#^a�f��r;,l, ' ����Sy�r�:=r��ti �t =�'�arn«�sp�a��'�1€r�hr�c�r ct��n�t�tg�;�� �_.:; � L.�t�r�i ��>e�if���tions � f�.1�� CJri#i��di�rr�t�t��fir�} Center Later�l conn�cti4n point � X 2;t�fi� C3rif'ice ���cinr� �ft) 2 Number laferals 25 QrificP�ll�ter�l P ��9.00 Laferal lenqth (ft} 1�.� Lat. discY��rg�s�k� (c�pm} �.50 Laf�:ral diameter(in) 1.5C� FarcE.main diameter(in;) �..�� 5y�s. di�cl�+�rc,�� r�tU (g�en) 42.a0 F nrcemain L�r�gth (ftj �13_48 TL�F-I (ft� � Typicaf Purrap �h�rrs�ier 1..�yout -- Hpproved manhole cover w�th �;�;��h�,,_��t,�,{ ¢ ��' warning laF�el ar�d lock;ng device ______.�, -- ---- jt�nc.+,ion l��x G �_ ��.__. . �inai grade - �_— �„ � � I ct scoimect �--_...,,,,, Ta�ik cornpo=�enf is -�� Aiternate ������"� progeriy venied "� - �-- ���� ����� oi,tlet � `, � tocation 18" min. 1 ' �,-- ------ --._..,___ �__ ,� j�� E�lectricai���er 4�Ei;3QC�at�d �,�•� \APDrovsd _� SF'S 316.:i01+1,�`�'AC _____.__ C�utlet _ T��k f;.il -- � joint � � I#��h�� � �altcans � �ruvi�e 1fa" Q A 2�.0 � 47�.9 av�ep�ioie or � B � fl �__� �2 b Alarm an — � antisipho� � � _. 3.� 489 ��.�m�a�n _....-�-g t�� :�evica. �_..��.. _�_._�.-- � t� 12.{� �1;t5.� 9t�-a0 ft � , '["otals 4�_� 75C�t� ----_.�_.�_ �'S� �-�-- -- Punip off � � � -_ __._ --- -_• � � �___ ....__� .�.,___�..�..—_. ,j�'3'8eddi�i�under't�:ii€s� - - - - $9.`'�G tt .%_____ _._______._��.__.__--� ��___�.__.._ - �. �._..._ �___.�.__ �.___..�� _ _ ,� �oefl�r P�.trt7� n�an��fact€sr�r ��.� �h�mbu� � Alarr-s� rn.��iuf�cture� N98 �_.��.�.__ --_�---�� Pur��mod�l number l�V�t 1�1�� �: Ai�rrn �n��c�ei�it�r���r Rrojeet: Hidcl�n ,Acres �3airy A-C�ra�ie Tr�ns�cticar� P����b�r: P���4��+� ,At-grade Sv�t�r�s (4�a�n��nan�e and Qperation Specifications _ _ _ ____e_. ._.� � ___. Service Proaider's Name R�at�khv�re�t Sanit�r _�_.��__ �,_., Pi�one �715-9�3 4�50 _ __.,._. _ P(�WTS R�gul�tor'� Id����� ������ Cour�t 7c�n3n PhQne 715-63� 8�8� � �` _�w�. �__.. ;���f�sre� �lovsr and LQ�c� P�rameters Design Flow-Peak ��SC� gpd Maximum Influent Particie �ize '�J8 in Estimat�d Fiow-Ave�age 3t�0 g�d Maximum BODS 2�0 mg/L � Sek�ti�a Tank Capacity 1250 �ai Maximum TSS 150 mglL Sol Absorption Com�onent Size 7�tr�.�? fks Maximum �FOG 3Q mg/L "�ype o�UVastewater �c�rt����stic Ivl��xir�ic�r1� Feca! �,oliform =1QE�t cfui1flfl mL Service Freq�,enc� �eptic�r7d �'Eirnp Tank��s�aE:��#and�'ar servit.�e onc��very�years �fffuent Filter {�ispect�nc� c(ean at lea�st onr�e�even�3_years Ptrmp�nd C;c�ntrols T�st�nc�every 3 years Alarr73 S�c��(d test monthl Pressure System Later�fs shc�uid be Flushed �n�i pressure tssted ever 1.5 ears Ma�rnd In���ct�or pondin� and seepa�e once_every 3�ears __' _ (;t�tc:r Mis��ll�r���a�s �onstructian ��� �at�rials Stanclard� 1. Ul�servatic�n pipes are slot#ed �r�d mat�riais confnr�rr to Tatale SPS 384.30-1, have a watertight ca{�, and are secured in as shown in th�at-grade companent manuai. 2. Dispers�l cell �aggregate confarms to 5�'S 384.30 (6}(i), �Ni�. Adm. Code. 3. A!I gravity anc! pressure pipinc� m�terials confarm tca th� i�Pquirements in SPS ;,84, Wis Adm. Code. 4. Til6ac�e of the i�asal area is �c.cc�rrsplished with � malc� laoar�;J ar ctaisei p1aw. 5. The at-grade structure anci ath�r cf4st�trbed areas v�rill bP 5eeded and mulched ko prevent s�il erosian and help reduce frast penet��tic�n. 6. Areas within 15 feet t�f the dc�wnsl�ape toe wiil be protected fram compaction. �. All otP��r constrtiiction details�r��� per khe at-grade cc��npaneait manual SBD-1 Q854-P (N. 03107). l.ateral Tsarn-up L��tai! Finished •so�w�eeaasw�s .� eco�srsessA�esw Grade ��,t —=�=�,........�,.�.._�..,. 6-�" C���meter Lawn __________.__�,. , ""�`-'�� —_ Tt�readed Clear�out 5prinki�:r V�Ev� Eiox -� t � Plug or� Bafl Valve Distribuiia�� — �_,`� '�r— ,�----- Lon Sweep 90 or Twa 96.2� ft ��:�. __ �`�� �-`�� 45 �egree Benc�� Same Diameter as Later�! Project� Nidden Acres C�airy Af-�r��i� Transart�on i�umb�r: Page 5 �f� �t-grad� �ystem Management Plan Pursuant to Si'S 3&3.54,l�Uis_A,dm.Code Genaral i�his systern shap be opera4�d in accord�nce v�ith SPS 382-38�k�1Vig.�1dm.Cade,�ancl shaii maintained�n acccar�lance��ith its'comp�i�ier�i manuals jSBD-')0&54P(hJ.�33IQ71,SSWVfViP F�ub.9 6(011�ii),��nd�res�.ure Distril�utinrt C4mponent Manuai V�r_2_Q 5Ba-�10706(N.0�101)j and local�Cri s#ate n.iles pertaining to sy�tem mainter�ance ancl n�ainfenance reporting. Na a��e should ever enter a septic or�iamp tank since dangerous gases m�y�e pres�nt that couid cause death. �epfic and pu�n�tank abanciorzmen!shafil k;e ir�aa,or�f�!�ce�rith SP5 3fi3 33,Wis Adm Code when the tanks are no longer used as POWTS componenfs. � Sepfic�r pump tank nTanhole risers,acr.ess nsers anci c�vers should be inspected far water tightness and soundness. Access openings used fQr senrice and asse�sment shaii be�ealed wafertight upan the compietia��of service. �ny o�ening deemed��sound,defective,or subject t�fiailure musi he re{�iaced. Expc�sed access open�ri�s yreaCar than 8-inches in ciiameter shali be sec�fre�by ar,effecfive iocking devic5 to pr�ve��t accidentai or url�aUtErt�rizc�i entry iat�a tank or eonrtpone�t. SaRkic Tank The sepfic tanit shail be�ra�ainfained by an individual cer�ified to serv+c:e se��tic tanks�nder s.28�i.48,Stats. The cantents of the se�tic: iank shaii be disposed of in accordance wiltz NR 113.Wis.fldtn.Code. The aperatiflg condition of the sepCic Tank and�utiet filter shaii�ie assessec!a#least ance every 3 years by inspection. TF�e au#!ef#rlter shal!ba cleaned as necessary to encure prQper cperation. The flitee cartridge should noi be remoued unless provisions are made to retain solids in the tank that may siovgh off ihe filfer when removed from iis enciostire If fhe filter is equipped vdith an afarrn,the filier shal;be serviced if the alarm is activated continuously. Intern�ittent filter alarms n�ay indicate s�trge flows or an impend+ng continuous a{arm. Tf��septi�tank shall have��its�onfenks rernovnd wfisn th��+�t,lum�qf slu��ge and scum in the tank exc�eds 1l3 the liquid vo(�ur�e of the tank if�th�coa�tents of the#ar7k are nat r�mcave�f at tf�e tim��if a tri�nnial ass�s�ment,m�ant�nan���rsoraaiel shall acivfse the U4vn�r of �n�hen th�n�xt ser�vice n�eds to tse}�erformed t��maintain tess�han�naxirnum scum artd sludge accumu�ation in the tank_ � The a�ditir�n of biologicat or ctlet�ical addi#iveS to enhance s�{�tic iaiik pe�forrr�anee is gen�raliy not required, Nc,wever, rf such produets are used they shall be a►�p�oved for sepfic tar�k use by Qhe DQparkmenz c�f Gon�merce. Pump Tank � The p�imp{dosing)tank siiafl I�e inspected at least once ev�ry 3 years �Il switches,aiarms,and pumps shal3 be testec3 Co verify�roper operation. If an effiuent filter is installed within the tank if shali be inspected and servieec�as necessary. At-qrade and Pressure Distributitan 5yste� Ns�k��crr shrubs sho��ld b�pEantsci on th�at-yrade PlantFr�gs r7�ay br�made�rou�id the at-yrad�'s peelmeter,and the ai-grade�hal!b� seede�7 and mu(ched as necessary to prevent erosion and t�prravide some pro�ecfion fram tros#penefratior�. Traffic(other than for vegetative rtiaint�naair.e�oi�the at-grade is rrot rec,orrrmended sin�e soil compaction may hinder aeration of the infiftrative surface waCf�in the mou3�d and snow compaction an the wsr�t�r wiil prn�r,aEa frost penetration. Colci weather insfa11a8o��s(October-h et�ruary+)dicfate that the af- grad�be heavily muiched as�rofecti��1 from freezir�g. influen#quality inEo the at-grade s�+stem may npt exceed 220 mg/L E�OE�S 15Q mg/L TSS,and 30 mg;t FOG for sepfic tank effluent ar 3{} mglL B�B5 3Q mg/L TSS, 10€ttgfL FOG.and iQ'cfu(100 mL f�r highly treated effluent. in�iuent flow may not exceed maximum desie�n flow specrfied in the permit for Th=s installation Ttae pressure distribution systerri is�3rovided wlth a flushing poinY at the and of each lateral,and it is recommended that�ach lateral be fluskretl er3 accurr�ulated solids at{east once every 18 months Whe�a psess��re test is perforrned it showld be compared to fhe initia(test +n+h�n�t#��:�systetn was htstalt�d fo�aterniin�i#orifi,�e cioggit�g h�s��occ�irred and if orifice�:leaning is rey�iired#c�naintain e�ua9 distribution wifhit�the dispersal ceil. Observation pipes within#he clisper�al cell sh�li be chacketi for 8#flu�nt po��ding. Pondsng levels st�afl be reported to the owner, and any levels above 4 inclies consider�c!a�an impendii�g hydrau(ie failure req�airirig additional,more frequenF monitc�ring. Cantinc�sncv Pian if the septic tank or as�y af Its ctmponen#s become defec4iUe the tank or component shall be repaired or repiaced to ke�p the system in proWer o�era5ng conditinn. if the dosit�g tank,pump,puntp cbntcois,aiarr��or rela#ed wiring b�comes d�feetiv�the de�ective componant(s)shali be immediately repaireci�r replaced wit'h a c�mpt�taetst�vf the same orequai perfc�rm3nce- If ths a�-g�ade cornpor�ent�{'ails to�ccept vv�stevyater cr beg�ns to discharga uvastewaf�r tG�the grour�d spriaca,it will be repaired�r re�laced in its'prese�t IQcati�n i�y incrsasing 1�av�i area if[c�e laakagQ occurs or by renov�ting the b�ologicaily cl�gge�absor�afion ar�d dispersal media,�nytelfing new�piping,and r��l��,inq oth�r componpnts as deamed necessary to bring the system into proper a�erating co�dition See Page 5 oF th�s plan f�r ths nanie and tele��hone number of your local POWTS regulator and service provider. i�rc�ject: Hitiden Arres D�ii���t-�c�,r��1� Trar�sacti�n N�.�mb��� F'ac��6 of � � � ,�----.---�_�u�� ��� ��__�..�. ,. �,319� ���i�� 1A�� : ''c� ' �k � ���� �'� � � �� 1�drt��� ���� ��� ����� � ��� � � ��ta�r-t���.��� ��,��" E�P�° Dis�aar�e �� � H�t�t�� ���� ���i�� � ���1 �4A �t�� ����� � ��ds _ � .� �, � : c����a���. � ao p ,Q�r r�at�� �ls ���� �� �� �� ��� ������e ��� � � �" � .��. �; � �� �� c��� ��t �. - . ,� � ,� ��'�;r�"1���� �r� ���� �b� _ _ .��� -. ; ��r�c�n���i� '/� ���� �q���qp ������ �4r4ZVt$tYiiRi.� F �'T�� �^"'i .. � � . .. � � ... � . � � . � �, . .. . � . .. �^�.� � a� � � � � �t���z ae � -� z�� ` ..�.�.... � � z� � � � �� �� 3� a� � e� 7� � �n �„�C��S ���� ��� ���� �������� ���� , � � � o" � y,�,;,-�i���' ,��`�`.:.���-�c_.�:..,-t' ��n `�r � � r .� � � � _ _ _ __..__ _ _ _�. - ..�, _ � � t` ,.��� � '� �. ���, l�,� !.� � � �g � �r f} \\ }� .j�l,'�L�.> t-:d'�� .— q ����ir. � ��l�'�� .`.,.., . \ 3" R ��__ �J� -----" . � . 3l� �``�'���:�t?d;lxdi, _ �. _._. -�_ �. {'���°'T L, (f� � Tt' ���°��,r^�',.--� ��''.�t>r� ��a� `''��b � ,..H ii !�---�' � � �.„_�e,G'" _.. 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'�''� 3 �..r....�_..%'' �� � r J . � �.�+ �� t.r^ < � � _Ji.�� �m+"(„.� . �. � � <.. r , ,��.�� ,�.�,. �- d �� �� '' f '� � � � �_. � ;i, ____, � � �------- 1 h�.�-�- �:'��°�'t-�, ;_���,.�L--� r��'```j � � �`�"�'��..�� � ` � �� �� `E ����m� � _ � ; ���� � ��. : � � c � ,� � �, ; , z ___ __ ___ . , � __ , � � § � , � � ��—_;�„���,.. � , �� �,_ - � � .�—�- -�,.�� � ,�u . _ � � � . � _ _ a � , ., �� � � �� � � ,. : �� r �______�- �'���� s ) i �,�a'aa�l C-¢ f�e'�€ V� '� � 4 i � 3,. 1 f fi s � � � `•..::�..�:'' � ,� _..._.___ � � � ;;�,�: .:. -+- �#':-a��i'L�.� �� 1 � �°� i �,�t w,;#- � Ft� 1.���i..'�i�JYt� F �f` W��%�� f r :f` ..�e�.....-._..,.. � �' --_•_ _��„�"'St.`_�.,....�- � ...�. � gq �^' � . ��4' ��� �g��y�^' `�, ��J f � ' , • ��.8 �y„s � �z � a� �,.__ y � �v � � S 1�i���i1•o-Tech���s. &Sen� ; .� t " tiE4���Suz�uV� �'1 Kii. .�..,�.A 1 L.�.�,.f..�±'.�.�,...z�".g,'�L.-;�..-��$..�.r_�-s_�� .._.,.... � • �. .. �-�------._—"— 1��e}�et�l�iaeus��r,l�'i�4895��97-�2 �� - . �_ . "� - � L n.;ll�es:,,tipii:�r? �I.� � `' i+l ���.��'�!� a: �7 � e - . _t�t��.__.._.._ ���.�;�1LiL�.�.�_ ' ' ' T�wn,hl� ./�'(2t;c�����cx>/t ro�lr,ry s�myer � �-��r����;� �.:,� ��-�-����-- � � ��_ --._ . - ; ; ';��+- !��� � ��a:� . __..�.._ __ M��____....� __ �h�v��;_,_�;� -- s�¢_ � �-,'_. ° � _ .� � � ---�-�-�.:- _ .�� _.�._._..�` � � ``� w_ __.�__..�._w__________..�_� .�..__ �. 1_____ _ .;',t J"^"M.,., .. '� a ` �����CAT(C}t�l �C)�,' R�VI�� Pt`Iv��a C�t�S(l� �� �. � � - -Compie�aitpag�s- �c�S��W���'i �1"���Ci1�t�� � � NQTE: Perso��a �-�fo'ria*ro yo��p o �e m s n� i ct����, se;orcary ac�o�s�-s �^�� ,��.� p.,�vacy Luw� ;,�4, .�. , �«is J ��5��'€1rlS { ,U*��-- _ __ _ i��b�iSiQ('0•'f^t�!.iSii�`J���Ji��?S — ... . .�..__ ._.,_____ .---— -- .__� . .�..�._ -- --- ..— . E �'}��r��S�C D�' �-�I�(�_ �C�VIC�� `J'il?C0F�t7lCiL'u5�1 flcT��`�i(;44. � �C, �;,,,:;.i�i(�S Gri�CK JU€tbu�S(TL�c�C hi��:l',���ww vVi Q0Y ---- _---- � � --- . _ �. �-.f�1811 iB.r.'?^l..'�� �t;uc.:,:�''St�G=S`.0 n,l.a_:G:`��}�-SJ"�p:b�t�r�t�._,__ ._ - i . _ ___� _—_ —______—._._'�_."" .__.—__ i Severdl�urtties have been defeaat�d ce�t�in aG:hcri 7=�o rev�iew�piGns�i� ��;ieu„��ivisccn c�fncustrv�ser��i��__. �ur a .,.,rre ��iist c: �"ose j counties a���heir�esi�r��ftar�,heeK ou<G���sits at`�,t:p.`r'asc��,^i_�ac�v � , _____ �--- -- , 1. Prv�eCt Inft�rnt2tio�-FEi1 in aiI Ecnown is�ft>tm�tion_ ConfRrmation of assignrnenY to a reviewer. � � � � TransacYinn ID: � j ProjecttSi;e^tame .f"1`l4�t'J� ���'� ��' "$�.�' 2� Q.�`:.... , i ! L�Catio,�.NURtbeE&SL'e8t f prot ct(:�i untc�n.row�t i� icated n ar�;s�ro�d i Qrevious Related Trans.10: f � �� �'� ���,�c(..T �� _ ; Es#imated Com�letior Oate:__ __ _,__�. � Legal Jes�rr�tior: � � Assigr�ed Revsewer. _ Coi��ty �""* ' '" ! Assigned Qffice: � ���,ify ���liiiage�� ' � Mai!tn your affice of choice be{ow: � Aiter plan5 are reviewed,p4ease: (c{�eck al!that aPply)��� i �a Crosse, Green 6ay � �C81i CUStOfS"!EC 1, 2(C:r'cl�"�i:Rtb�r'j` M1iOTE: We reserve the right to r�-distribute�tsrss ta anfl€h�r of#i�e if � Requestirg party will p�ck up � n�Q����fl E�asonabty dalance turna.rourad titnes. Check htip�/tdsns.wi.anv for next avaiiab�e review da#e �� �'Mail plans to cus�mar'{,�(circle n�mb��j� � ,: i � �„���� 'Refers to cusiomer number fron-.oe�ow , ' ` ----- ------- - -� �____ �_.__ �...�.�____---- _---___- _ �� 3. Gom�11��'h�folio+t�ing desi�3r�ert�awnerirequ�sting intorznati�in. Utifize khg�heck Hoxes vrhen d�sf�r���,ow�ner�r r�c�.sc�fing party is the��m�r,n avoid cepeatir�g informatron_ �. Desi igner�inform�tion(Custorrter 1) ---- �S°� �' Other Piease Specify S�low(Customer 2; �_�� S - �, �i i � Ficst 3me a 'tias'�e G...tomer N��be� i � F me est: a �� .,ustomer Nur b�r i __����^��-�__- — —�����"'--��=- --��--_� . Carn�.y�l2me ..-�-°- � a � Curnp3 Y N � � , � f � " R ��� • �,'������c".�i�'>C.�-� �� �_�_�.��'�.__.t�.�-�-�:�.-�..��.��""- -—_--- ___ ���d°'�""f�,� a� � --- _______�___ fi �' � ,_� ;�ddr ,j�� ,�.... _ � �} ,r Add s� � � ���� �,��:�_ ���L�..%t.���='�'�..--i�-� �` �'�r..� � �_r_7C_�� � "'�te �:p+a �d�its, � CiN.....- � Stai . ��.i�,4��,ici't� � �'� I G;� � i � , � ����__—__a����—.�__��.�sG, �����_ __�'� � � -—. � , , � Phone U maer t- ail adclress Geli ohQne � PF�une hurcoer E-maii addres� �e i pn�ne (2rea Cpd2) . " � !a[e2 GOd2; i �. ��������� �� F l�Bi'� w__� ____.__---`__ _� _�, -�-.__�-_._5�.._.____ ._ - � . ���-�! ����..�� � Check if a�pl4c�bze � he i��f 3��I�cabie or�pecry;elai�orship 1 ❑t�wne; j���'��.�'".lyr'�.�-'�� � �� �G��vner ❑Oiner-s�ec�f��r �a[�ansh;N _��___.__ _� , __------ _ _ _..__ __._.— _ --- ' � lnforst�aEion and Plar�Submittal CE�eckiasts. .�o r��ues;s� t�..�„c p�an r�L Aw �rp��t�t�.e a�e-ec iate��p!La�sor rQ;~��r�� � ^�a!;t � ; aiong vrith�{our registered SharePaint usema�ne to DSFSSBF�ar�ScheduieCa��1�4`isconsir aoU�. (`��ans are being svbmitted via paper.they ! �vili be assigr���t�a reviewes aifer r�caipt�`a C3SPS c�ce. Suw�mittai c;��ckliss can be€o:;n�in�acn applicab`;�com�onen�mar�uai 'k a��eadn�a�t 4he POihfi'�pr��rasn Ga�e�r��ar Pubiica�ons�'04'VTS Cornean�fts tUtanuais -.� ' _ ,-�.� _,__ <� �,��e„��,-,. � - - a � �� Green Bay�qSPS ( La Crosse Ar�a DSRS i 3824 Greekside�n i �=31 Sar���uis�'iac: ' Holmen.W1 54036 ' »reen BeY.vV�5a3G4 � 6q$785-�'�34 92�-4G2-5601 w E ax 4?C ��2 5�v"4 j Fa�e. �'J8-r��-�330 ` �� EmaIC �sSbPta�rScherluf�k�i^��a i crnai�.�sps ��'(3r� �.����;� e� wi.qav_ �.._-- ' s — - --- --���,.:.�,a I Make Checks Payahfe to: L3ivi�ion of IndusEty�ervic�s t�� � I �=-� � � Chec�C �oxto invt�i�� cies�g�er and sign be4€�v�r i TG-r���a�c�,:�rar cau� ��°°�.:��� ; Reo•i�w cod�7633 � Des'sgnes signatnre_ _._.___.- ', S6�1-10577 tiR 4?�$1 �� � —� a���� � �� �!;r ���� W a'`�.'��t��� ���'�� � � ��.'���. �"'= ��` �-�_.. - , `�•.,,, � ' _---- � -V��- `�_'���� �s�1��'�� � y _ �,,...�--- � _,.�;��,' �' � �`�, �� �� i ,�t �� ��� ,�" �::,�= ���d'�� _ -,'-- � �� � — � �a��,.,�� �r � . ���� �, _ �; ��� �� f . ,y- ,�'�r / . ���.,xy '"!:. ��.. / �••���'�.r�.+—.�.�•+r.,..�. o_,a„\ ^^;'� S 3 �� , .�y !� �.`�.�'"3����'�.... �. , � .� , � r � , � �•' � . .. � ... 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POtN'C'S SU6fi9Ct'S"A�.(c�eck ai3 ti'iat app3y-inao:r�lete tamss rnay tesuit ir proce�ci�detays) -- �� � �—.__.�__..... ....__._._._.._�._._______._.,_--------.._._..�..._ --_.__._...._— �.--...,___. �N� (.�Aerahia traafmant Uni�s7 ��Chfocinator [�7anic Re�lacemenz 4nty .� .�� �. R@?LACBfr�EYF �'1 t',�nartercisi Sysfem `�UY Chsmfoction Uni' ,_�'j Add Eftiuent rilter � � � ' ` i_.___ __ SYSTEM IYPE 5 -- — —.-.— �� I 1 NO?�c SuOm€T separacg sh¢ets for each sysEem f submitting mul5ple system.s or ti.e seme s�ts EnYer Fes � --- --`- — ._ - � —._ � ----- -- — --�..v...�..._.�rt [� Reviseoa to pravpously ap�rQved piaxT 585.00 � �7 Mi�cetfdnewus Rev�ew{.e.replaceme:i:tif a sep6c Lank,addi6an a�an efltu�n?filter er pratreatrnent devi.;¢to an existing system,etc.i bSO�hr �� ------ �� r----__. ��. ---- ..�. __ ._....____.._...---. ....-..-----.,__..� .�_____. . . — ------- -�----- : ��v,zm. ..n,f,4a a __ .�..__----. -�,1 . c �rr ,.� en ...�51�.poro;r�? h-C';aoeCar^p ,.�� tarud� Ye, � �tsu-��.�A.c3 *�, .�. $�� �'�� � co '�..;^ � 1 j � � , ''a3s' d._rr'.uv � � : �. �In-greunC...o�r�or e^t �a�� Va_ 0 55;-iGit,G �,N- r i��12i �2�c�s Per day �es�y;�w�y ntva er .cw_i��e�;r�e�.:se.:syster^ i ...,, ���.> � J�Mound Compor��t Nia�ual-Ver.�� a�G-iC�rq p(N Ci,�_R>Jl,ii .�. `� i �AresSureL3;strrt�ttionG;mpr;�e;tPMan�;,;i-Ve 2.C,SBC°-?�'C�'s-,-^(N.0`t0i <""ur��'� i � '� r{��� �+`,'��. i � \ �� �C'Fer-Please s�sG'�y �.p �:ypa a ess� i S.� -t. �,+_>- n u% � i - -- �_— ______—.___--- � �t��- �� -�a � _____ . �4:�4'? ; � []^�^ai!Basa:1r,tli��uti Srta Gess�n' or c._7.,reatrn�a'cc:�:rvn��s are'_t � � —� ; E G a.,.::sS F.r�'iE;.�� .s.S�' 3q4.�.�i"t `3y. l i �AtGvads . � ,� I c �_<_iy �nv 13n r �.ompu�en No'rPress;.�r�?c:in-grn.:rni - -,as;�,,, j � „ai :;oP -�..�-eot�n .,a.._oro �.,,, � �Pr�3wr�rs(n�rounc c4asteha:e•=h-,s r� ���ea,:. u- � �Ncand ,3a1� Prr�ay i �'. -�e��an:r-ste�n�ata�9avc`{h? �� sedsyst�^ _ � � ❑'�np�i�e p- po . [�Canrs`r�,�ed UYe�lands ` r �CC 4r� �ess S,�:7G� '. �""'� ( �ocW7er�b'ia�musf aa�,av>CaC[o s�.b �t:rea er[a'a��G�spersa;�i���;s !^a se Gp.� . P� �dra�s I ��t-t 4E��qcc �''' �t� � = s:atement orouue rationa�e o.�;��P ne�Ct ar�ci a�a,.k5ua�Ott ng�ac.�,^�enfs(a�?e sec:iar�..�st � 2�'-..7,G��-�rQ 574�.DG � � re�ns;=o!Z�ica'pape;5 resaa�sricles.e'.c., � � yrez=r t a�5.^EJO SP� C9 iY; � { i (� - �___._..._......_____ � ois�� 3�areaG .alu,�cv,r5�`�7;Rtl . ( S6zE�-cvme�#aciC�Eea: � -�ol�i y �, pr�v�u�y Farov���der a��5 _� _- � L ej:n ,rk..5� 2�3 C?eszg,-,waatewa�.s�flov�ef;he ' �`�1 Noidir,g Tars��Compo�en:M�aeGa{,Ver.20.530�.or�„P�N.Ca+C�t.ft,�12�r i *'�stew�te:ri.,tv�r. cropo.va ��s...n: � j � C>alio:s Per dap � � ; i 'Nors-stats arec Ccmme�ai anel Residsr,:iat Hoid.ng tanKs tnec mr�p�a'ei��.5(¢e�'�is man�at � � 5.�0.7 g �or!e:s S 3C_U= � � -`: ano hav8 an eslimated daily f[aw cF Izss tha-,300C xiions�er c5ay rus?oe s;tbntttc�tc the a.OG!- �06p gp: g,�;.p� � ----- � aP�Rate gavemmenYSE�,�n�f for re.,ew nsread of��e Departmert.[sse SP5 3£3 32{�faj; . �G�� ( .ea r�tis �J'�R�.��cJ . S<5 00 ' ��: . _ _...,�... _..--- . . # _ �NJo-�mg^"ank l��v�du�!5he 6e.si +�.P.sts reast�,�cied w eay Q_,�rr:�r.apac.rT-C�- e�c�� ry c 4C���s:.e:ans cter ts�Ks NCT __..__._�_.� �mingie�swastewa:e� �tc-; �� . . . ❑sqr � w,;us,a�cro.ea�r,tle�s.SP��_7�.;;2'or3; ! P���ease sDe:;fy� �al���_r�.� �''S'^y^,� e �ca:e-,` �� ' e pr�.�^Fe�S}'gfe'r � piease�inc+utle sit�..�.de acti..ns,test�s pPe;,nP r cr.��o f'er t.e p:��ci. r a�soara;a stat�r�er,;, � 5 3Ct'ca � , S@�'.JO ' . pott5.'�rhricaipao�rs rcz.�aar:,ha�i:..(es,�tc.} � 5 `�' � � �P� �3CR.nD � � , � I GPD � ��at�� �L�bP� �,.�.�JC E ; � � � � �� __�__ i ----i-----.._� —, i �Soi3 Saucrnlon Qetem�<na5or Reaor:{usina cbserv�an cdpesl '�,�„'a in,e•a�tve De rnin;��dn S2a6_�ID� .�' •cxpe^m�i Syste�t:;?ne Sna a�,Rrer;ai 7eai_��bm,�t�9�;n:tndiraudt sys�er.-ae„er ap�roF�.�=e_,acve s�.,:�.�'ryP�i _.�e��-�e: ::u.�Cer_ S4i�.��� ��- —� ...ari .�v�ew;�+i[e:-;ame arro,.�,:as som ;rG�,-�.•-e is:e:ac:�,•e' g,�C"�� . �{� /^q $)�.� - Ea3ar 7ata{(r3ur,ded tc�e nearn�«doila�i ��k-s .SB�-i�G�!jt'Z���� `''"""'`` PRIVATE ONSITE WASl'E TREATMENT county �= >;, /: , ��/ �\ i�� }o$ \��; SYSTEMS Sawyer ����� �s ��i` ( POWTS) ��-_—=�i \Fss'""^''`- INSPECTION REPORT sanitary Permit tvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 2� —�S3 Peisonal infonnarion you provide may be used for secondary purposes[Pnvacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village �,Town of: State Plan Transaction ID#: ;e` �M a� ��o e�5 YVle�.a... b��,G �� �o���o� 1�3-C. Insp BM Elev: BM Description: Parcel Tax No: ���` o-- '�e.�� a�b _ 637-3� -ato� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �.{ � ^ � � Benchmark jpp,e' DOSing � Coa,.�a ,�D �l 2 � nj Q�i ` Aeration Bldg. Sewer q,s 3(,` Holding St/Ht In�et �t K•7(,' TANK SETBACK INFORMATION St/Ht Outlet qY.Y� ' TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet AIRINTAKE Septic �1- �-�� �� �- � NA Dt Bottom `j0.6(, � Dosing �, « ,, �� NA Installation � Contour �( r2� Aeration NA Header/Man. Holding Dist. Pipe Q6.'7 PUMP/31PHON INFORMATION Infiltrative N�{b— `� '��. Su rface Manufacturer �o�( Demand Final Grade Model Number �'g GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L �p� Dia �` Dist. To Well DISPERSAL CELL INFORMATION DIMENSIONS W ` L � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv � Aggregate INFORMATION P I L Bldg Well iNaters � �GP ❑ Chamber -- AG � EZFIow Model Number: CELL TO ,}-� ' � [� � Mound L7 Other - — — — F-t---- --- —____— ---- DISTRIBUTION SYSTEM x Pressure Systems Only _ _ -- -- -- ---- --- Header/Manifold Distribution Pipe(s) �� X Hole Size X Hole 2� Observation Pipes Length Dia 1 Length�`� Dia_�_� Spac — � ,� Spacing Yes ❑ No� -- — — — --- SOIL COVER - - — - -- Depth Over N Depth Over ,, Depth of �i Seeded!Sodded Muiched Cell Center 1�' �ell Edges (�" � �Topsoil 6 _ �Yes ❑ No � f�Yes ❑ fJ� COMMENTS: (Include code discrepancies, persons present,etc.) � .'�� II �`��2-� Plan revision re uired?0 Yes 0 No �—� i - a a 3 a� � � � Ga ��� _ _— -- --� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBER: _�o� "���_._ ; , _ : .__�___ : _. _�--.._ _.. ,_ -- _..,__ ... . � : . . : . - - - -- .-.. - -- _ ._ _ _ : . .. _; _ :. � _. ; _. - _� . �„�-c�,� ��,�1�� ,�„� ��� �v�� , , _ � ,� _ _ _ _� .. __-; �— __ _ .. , — � ` _ , �'�e��,`. �' .,. ,q,�` . ; , � SD r \ ± 6, \ �'� �P�� r� � -� 6' �� �/ �� ��.� '� �� 3 6� � ��� � � �� o� �' �€��c�' � a � c � ��s � � ��,. -�LN S�-