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022-738-26-5303-SAN-2023-251 i A 'hit � - ,�, �� In�ustry Servioes bi4rsiun Co�mry _ [� � .. . J > >� :�• . 1400 E WashingYnn.A��e J�4U1�� 3�" ,��` , �� P.C).Box 71b2 Sanitary Permit Number�to be fill�ci�n h}�Cu � � �ry� � h9adison.WI 5:�70'I-7162 _ � (,� S f (,��t �� 9.� -- J ,� ,� �c`��C11�e�.Iy' pCt"I111t 1�1�7�}�ICc`��1011 S�teTran�actia��s�mt�er —_ U in aceordance u�ith SPS;83 21(2),LVis.Adm.Code,submissian nf this fc�rm to tMe appropriatz governmenwl unit � is required}�rior tn tftrtaining a ktnitary pern�iY.Nate�Application fbrms f`ur stt�Ce-owned PO�%1'5 are submitted to Project Address{if different than�na�ling�dd-c — .h�L>epariment o£Safety and Pro#'essiunal Services-Personal infonnatiun you prnvid�map be used for secondary � u s�s in accordanoa with the Privac tatv s. 159�1(1 Xm,Sfats. t. :� licutinn Informatian-Plense Print ali Infarmation 3076N White Pine lane � Praperty{�tivner's Nums F'arcei# - ` , Kyle Payne or Judy Dirks 022-738-26-5303 �J f'ropem C}��v�ner's Mailing Address � PropertY[,acation � � 1120 Windsor Forest Dr. ��-�� .�� Ciiy.State Zip Caie �'hone Number "-'-lA��'�_.Prj, SeGtic�n .�-�O Altoona WI 54720 715-606-1021 T 38 N` g , �� [I.Typc o�Buildieg(check all tMat apply) Ln�# � ---- � � 1 or 2 Famly D«<eliing-tvumber of Bedrex�ms 2 1 Suhdivision Name `W }31ock# ❑PubhraCnmmerc�a!-Drscribe Use ------� ____.__...._.-- -__..---_.. � ^ Citv nf ! . __.._.__. ...._ ________ � ; ❑State C?wned-Descritu 175c CSM Numt�er ❑ Vi(lage of' _.......-- _...._--- ---_.. � _...___.__._..,.....__ _.__._.�__._____Y_._....._ ; — � �"1`�wn at`_R3d1S,QI]__ J � ![I.Type o[Permit: (Cl�eck only one box on line r!. Compiete line B if Applicabie) � "'��--"'—`; � A. ❑New Sysicm �]Replacement Sy�st�m ❑TreatmenUl iolding"Iunk Rcplaccment Oniy �Otfier MnditiouTiqn it�Existing Sy5tem(exptuin) � �• ❑Permit Renew�ai ❑Perrnit Rcvisioa ❑Ciwn�e af Pluii�beT ❑1'ermit 7'ransfer to New �''st Previous Permit Number atui Date Csstiec9 � Be�fore Gxpirati� Owner (,��. � IV.Tv e af PpWTS Sv�stem/t:om onent/Device: Chcek aii that a lv ( [1 Non-Pressurized L�•Caound �Presiurized tn-Gruurid ❑ rit-Grade []��iound>?4 m.u#suitable sui! ❑Mound<,�,4 in.nf suitRble si�i] � � Hoidin�Tank ❑Chher Dispersnl Component(explainj_ _ � ❑Pretreatment Ckvice(explainl...._____„ __�_._...__-- ,�'4'.bis ersaili'reatment Area Inform�ttiorr � � �� - � � Cksisn F'o�ti(gpd) 13esigl�S�ii Applicarion Rut�gpdsi) Uispersat:1rca Reyuired{�t� Dis�rsal Area Proposed{sf) Systcm�'Icvaiion �� na na na na 'l.'i'ank Infa Capaciry iii Total N uf Manufactiuer Gnllons Gali�ns th�itti i n�o ,y, Zvew Tazilcs F.�sting Tanks m C M � � � � �� a.t.: v v� v� a.. C^ c. � Saptic or Holding Tattk � OQQ X Skaw X Dnsing Chaniber �'It.RCspvnsibilit)•Siaiemeht- 1,the undersiKned,essuzne res�nns�biliky for ins�uliation of tbe POW"1'S shoa•n an the attached pienx Piumber's Name(Print} Plum 's Si�nature � \ � R11'�'MPRS Numixr Business Pht+ne'�umber David C. Laird , ��.�c : ��cc4-� 221253 715-239-6194 �. ____� Plu�a�ber's Address(Street,City,State,7,ip Cnde) � , � 20165 Co. Hwy "Z" Cornell WI 54732 � �'Itt. :o �IDe ariment L`se Onl� �r r ❑!:)isapproved 1'erm�t Fec T7ate Issu�� Jssuin�Agent Signature � � �y,,� � ❑Owner Given Reason for I)enial ��.� �� a- I•'2 3 "�tc�:�� 7�""vt.+`� � I�i.t;onditians ofApprovatlfteasans for.Disapprnval � �� -��"� l a3 �rr( �� r�al ( i � � � ..,��2.� �� -_ . � E ' - � � '� f._`'�1�c�_..._��1,�._. . ,.,,�k..... �t CC¢JS c� �.S a� ; `'� 3:�� K� 1ti -�,�. ; At4tch to compkte plams#n�t sys ` � it�besi*f�lF�eE?e�nflTmeiyen�m�tless tAxa A 112 x I!inches in s�ize t.-�.-�^;;""'^ CS��_ �3__ � �',)� �,., ,� , � 1 U 1[`�•.,t ' ,�_.��:i-._�_. � r� ��:�; sr�r�-63vx .ox�ra) NO R�FJN��AFTER �L SF_�' 2 9 2G23 J. 13S�JL U�F'��i�l"i --------- i-r•.. �l'„l�l�'r�tl L+'.J'.iSV! Y ZOf�f{P�G AD�AINISTRi,I�ION a-� 7�1 � Sawyer County Zoning & Conservation Administration 10610 Main Street, Suite 49 ��11 � �R Cp �� Hayward, Wisconsin 54843 � 'l�' ��Ci � (715)634-828R S1� �'L �j �Q/ � � � FAX (7l5)638-3277 �� _ -� �� / wwwsawyercoun_ly�,o„ v.orQ � o � � �� -- _ �o j E-tnail: sanitarian(nsaw�crcountygov.o� I��=� ,_�s�� ToIlFrecCourthousc/Generallnformationl-877-699-4110 ��s� �NS�� ( �� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �� / 2� / �.3 Parcel ID# o � �- � 3 g .2 �o - S 3 0� II. Plot Plan: D� Property Lines D� Benchmark BM ♦ �CSite Address X North Arrow D� Structure � Scale �Well p� < 2S to Service Road � Legal Description X Nearest Road Intersection � Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: Index Page with Original Signature Management Plan/Contingency Plan � Servicin� Contract � Holding Tank Agreement Fonn ($30 to ROD) IV. Holding Tank Specifications: � Tank Cross-Section: Manufacturer: Sk� Gallons: �O�pU � Tank Anchor Calculations [SPS 383.43 (8) (g)J � Locking device, chains/locks �Alarm, electrical per SPS 383.43 (8) (e) � 3" Bedding Material < 1/2 ` V. POWTS Component Manual Reference: � Holding Tank Version 2. 1 (May 2022-2027) Owner: �aT��,r �S Plumber: �9�� Application Review Date: _ D`� (�9 r�3 POWTS Reviewer: e� "l� Name _ G�� Rev. 4/27/2023 Credential # CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Payne H.T. # J J CJ v P i n'K s Owner Kyle Payne Address 1120 Windsor Forest Dr. Altoona WI 54720 715-606-1021 Legal Description Township Radison County Sawyer Subdivision Name job add.3076N white pine lane Lot No. Parcel ID Number 022-738-26-5303 Plan Trarsaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Soil Data(A)&(B) Page 5 Boring Locations _ Page 6 Holding Tank Agrement Page 7 Servicing Contract Page 8 Designer �A✓tA C, �P�1!"<J� Signature ��,.�,��, �w:<� Phone No. �i�-�3 4-!�I 9*� License Number 2`��aS.J Date 09/11/23 Designed pursuant to-. Holding Tank Component Manual For POWTS(Version 2.1) May 2022-2027 Version 7 1(07/22) Page 1 of 8 HOLDING TANK SPECIFICATIONS �Number of bedrooms Non-residential estimated flow(gpd) 2000.0 Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capacity(gal) skaw Tank Manufacturer 2000 HT Tank model number Rhombus SJE Alarm manufacturer 101 Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16100 Ibs Weight of tank and cover 49.0 Liquid depth below inlet invert (in) 1.50 Safety factor 3.0 Maximum depth of soil cover(ft) 19748 Ibs Weight of anchor required 65.0 Height (in) Outside 33.5 in Soil cover req. for anchor or 146.5 Length (in) Dimensions 4.9 yd' Concrete counter weight 69.5 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished ��ent cap junction � warning label grade box � � — 4"min. 12"min. �� 23 in. Manhole and vent locations conduit —� vent pipe 18"min. � tetherweight I � ._._._._. _._._._.—._.—.—._._.—._`L._._._.—._ - building sewer � service � 12.0 in. _ _ ___,__. inlet blind plug aiarm on I Note: All tank joints, and to seai joints between tank outiet openings and piping are Electrical as per 37.0 in. sealed watertight. All NEC 300 I pipe and vent materials and SPS 316 ! comply with SPS 384. � 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Payne H.T. Transaction Number: Page 2 of 6 . . S � rE P� �n� Oc� N�'k ' �, ocATjonl ; Ky� E� �1i9� �( � Ca SAt,.�y �r rN : RRD� s o�! 11n2� �J,1 N�.�,� R �� a t3 A� Ptl�s� : � _ �_ sz , FoRf� � P �E . . � L?Q�I� R c� l S�7� d 3a ; 6x u,/N � rFP,�rc_ cN �� ,�S �,..�.:f m � l� R (-�- D�� o N Ul/ 5� S�-7 �� baa- �3g - ,�� - s303 �a,,;,,.� c . �Gi-w?-� -- --_ -- „� _ . . a d l(9S c�o, !�'1 c.1 y ,.z, , � � CG`�,�'NE�.-�- c� i ��'"v 7 32 � i ii"S-e�e :S 9 —�/ �) `� ,. � , � ti y��9� � ___ __I__------ .-- � -_ _ __ _ ------ --� GJ I�.� 7'� PiN� 1.�, 3,m, _ ►oo ' �� . � __ __ _ _ 'j"o'� oF �QD�,J� R� ��; /NSTRIj I � f}�, I Lf j'c1� e�l.,/��' �` '2r`� G�4 (� ��.T j �0 � r�` �c1f�E' f �J U' � ��.1�4'_ (^'R?�j V "` . C�LLJ9�'rIJ � ��L. iry� ` SE�"�`�c 7aCOvy� ,.yt�Ll� 7� ,�k � �_ 1 � � � ' f Il I � , � I o �d �� ► I , I �C � �' � ,,nr�o , �o,�a � r __. --- _ ..� �_ ___-1..__._--- .�. . .. , .__ ,- 1 � ., .___ _ _ � f: . - - _ � -. � _ _ _ , . .__ _��, ,� A gq 53 � f � , - , , � - �- ��i' ' , _ � , ,. �t r�__ �_ � �.rv, .-L.-, �-. __ ._ ._ �� vER� �- _ _ G�` � ��'� 3 0� g HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System(POWTS)has been designed,and is to be installed and maintained according to SPS 383,Wis.Admin.Code,the Holding Tank Component Manual(SBD-10855-P N.03/07,R.01/12),and the Sawyer County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 20.0 to 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance,including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90%of the tank(s)capacity or a level of 12"below the inlet (at which time the alarm will activate),the pumper listed in the current Service Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113,Wis.Adm.Code. 4. At each service event,the service provider should visually inspect the condition of the tank,risers and manhole cover(s)and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis.Adm.Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. 6. The owner may not remove any of the wastes from the holding tank(s),or cause such wastes to be removed by any person not authorized to do so under Ch.281,Wis.Statutes.The discharge of wastes tank to the ground surface,including intentional discharges and discharges caused by negiect,constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases,and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired,a code compliant replacement holding tank may be installed in the same location(a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced,or its use discontinued,components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis.Adm.Code. 10. If there is a problem with,or question about this installation,the following persons may be contacted: a.Installer...._.._.. . _.__.... David C.Laird Phone: 715-577-2870 b.Service Provider............... Phane: c.Co.Zoning or Health Dept. Sawyer Co. Phone: 715-634-8288 11. Project: Payne H.T. Transaction Number: Page 4 ot 6 HOLDING TANK SERVICING CONTRACT Contract Dalc: /�/ 1- This contract is madc between the Holding Tank Owncr and the Pumper. Holding Tank Owner's Name: Pumper's Name: ky` � P�'/`�F �yf.Zt�-�f� J J Dy DIRkS ��t Parcel [dentification Number: (12 Digit Legacy ID) �;��-z 3 g - e2 �. - 3 3 a � 1. The owner agrees to file a copy of this contract with the governmental unit, Sewyer County, which has aceepted and recorded with the Office of the Rcgister of Deeds, the Maintenancc Agrcement for a Holding Tank required under[he Sawyer County Priva[e Sewage System Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s). 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantecs to permit Ihe pumper to have access aod to enter upon Ihe property for[he purpose of servicing �he holding tank(s). Thc owner agrees to maintain the all-weather access road or drive so that the pumper can scrvice thc holding tank(s) with thc pumping equipment. The owner further agrees to pay the pumper for charges incurred in servicing the holding tank(s)as mutually agrced upon by thc owncr and pumper. 3. Thc pumper agrccs to submit to thc Govcrnmental Unit, Sawycr County,a rcport for thc servicing of the holding tank(s)as rcquircd undcr SPS 383.55, Wisconsin Administra[ivc Code and[he Sawyer County Private Sewage System Ordinance. The pumper further agrecs to include thc following in the report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. Thc sitc address of thc holding tank; d. The date Ihe hoiding tank was scrviccd; e. The volumes in gallons of the contents pumped from the holding tank for each servicing; f. The disposal sites to which the contents from the holding tank wcre dclivercd. 4. This agrcemen[ will remain in effect until thc owner or pumper terminates this contrac[. In Ihc cvcnt of a changc in this contract,thc owncr agrccs to filc a copy of any changcs to Ihis servicc contract or a copy of a ncw scrvicc contract with Sawycr County within tcn (10) business days from the date of change to this service contract. Owner's Name: (Print) OWll�f 5 SI�+I1dlLL[C: (Onlyoneownersiqnaturerequired) �:�� 5 � � � i Pumper's ivame: (Print) Pumper's Signaturc: !1 .�S 'i��1� Pumper's Registration Number: �1�7Z �p /� Rcv.03/26i I 3 \ I v � a F o ��o No pO,�S MAINTENANCE—� I!IIIII�I�il�II III'I!�I'III I!I AGREEMENT � DocI :o17C333 For Holding Tanks � Tx:404i715 �N��g� 446619 PAULA CHISSER REGISTER OF DEEDS J JDY �i�kS SAWYER COUNTY,WI 09/29/2023 01:19 PM ParcdldantlflcaUonNumber(PIN) ngreementDete . RECORDING FEE 30.00 o.�:z-�3J-�� -5303 9-iy-ioa� Legai Des«iption dProperty � PAGES:2 #3076� WN�ir P,i✓E �A�Uf I ,�L. s.uc. 5�� I ea�m� oT Sawyer County Zoning Dept. 10610 Main Street,Suite#49 Hayward,WI 54843 As an inducemeM to the counry to issue a sanitary permit for a holding taMc on the above-descnoetl properiy,the ow�er agrees to contortn to ail applicabla requirements of Chapter SPS 383,ws.Adm.Code relating to hoMing tank management,inGuding the foilowing: ' t. The owner agrees to contrad with a person who is licensed under Ch.NR 713,Wis.Adm.Code,e�ept as provided by Section 281.48(3)(d),StaLS.,[o have the holding tank properly serviced and to file a copy of the service oontraci with the govemmental unit. TTie owner turther agrees ro file a oopy of any changes to the � sarvice crntrad,or a copy of a new senrice conVad,with the govemmentat uni[within ten(t0)business days from the date of change to the service conhad 2. Trre owner agrees[o conVact with a person licensetl untler Ch.NR 113,Wis.Adm_Code,wt�o shall submC pumping raporfr to the govemmer�al unit in acmrdance with SPS 383.55,Wis.Adm.Code,for the serviung ot the holtling tank. In the case of exemption under Section 281.48(3)(d),Stats_,the owner shall submit the report to the govemmental un2 The govemmental unit may enter upon the property to invesfigate the condition of the holding tank when pumping reports may indicate Ne holding tank is not being propeAy maintained. 3. If the owner fals to have fhe holding tank properly Serviced in response to ortlers issued by the govemmental unft to prevent or abate a human healtli hazard as desaibed in s.254.59,Stats.,the govemmentsl unit may enter upon the property and service,or cause the tank to be serviced. Pursuant to s. 14520(4)Nfis.Stats.,a govemmental unit may assess the owner of a private sewage system for cos� related to ihe pumping of a sepfic or hokling tank.The charges will be assessed as p2scnbed by s. 68.0703,stats. The own�r agrees to pay all charges and cost incurred by the govemmenfal unit for � inspecUon,pumping,hauling,or otherwise servicing antl ma�taining ihe holding tank in such a man�r as to �. pre�ent or aba�any human health hazard caused by the hoWing tank. 4. This agreemertt will remain in effect only untll the govemmental unit responsible for the regulation of pnvate sewage sys4ems certifies that either a soil absorp6on system that complies wiM SPS 383,Ws.Adm.Code, or a munidpal sewer serves the property.In addition,this agreemerrt may be ca�elled by executirg and recprding said certification with 2ferenoe to this agreement in such manner which wilt pertnit the ebstence of the certifiqtion W be detertnined by reference to the property. 5. This agreement shalf be binding upon the owner,the heirs of Ne a�vrer,and assignees of the owner.The owner shall submit the agreement to the register of deeds,and the agreement shall be recorded by the register of deeds in a manner,whirh will pertnit the epstence of the agreement fo be detertnined by reference to the property where the holding tank is irutalled. Wmer(a)Name(a)-Plaase Print SuDscribed s co nerore me a,mis eace: J�d b��k-s � 2023 ��B) �B^�++�a(s) Nota P I�c _ . -- ' � � �� ar e��/ -> My Comm'sion E ires: 0 3 202 ,�,.,,,, „J„o�,,s o.atceany: Davr� �•�.�[i�� :°�Q.`�.•••�..... ...9�,, c..�w��w,a�.��.re.�..aw+«�.d*ra.w.��„A�.,....�s.aaKm>i : ::��TqR��._�''; s = _,_ _ j'�Z 7oF 8 'N9'•'°UB��.•��: ,,�OF�SGO�``,, Tha�part of Goveriinlent Lqt 3, Scction 26, T'o�vz�ship 38 North,Range 7 West, '1'o�vn af Radisson, Sawye3�County,Wisconsi�y, described 1s follaws: Beginning at the Nort:heast corner oi'said Government Lot 3;thence 5outherly along ihe West bank of tl�e Chippewa River, a clistat�ce of 76?fcet, this to be the point of bcginning; Chence Southerly along the river a distance of 73 feet; thence N42°30'W, a ciistance af 346 feet to the center•line of'a Town Road;thence Nartherly alang tl�e Town R.oad, a distance of 73 feet; thence S42°30'E, a distance af 347 feet to the point of begimiing. 9129123, 1224 PM Real Property Listing Page Redl EStdtC' Sawyer County Property Listing PropertyStatus: Current Today's Date: 9/29/2023 Created On: 2/6/2007 7:55:36 AM �Description Updated: 1/5/2017 � Ownership Updated: 8/14/2023 TaxID: 22791 ]UDITH DIRKS ELK MOUND WI PIN: 57-022-2-38-07-26-5 OS-003-000030 Legacy PIN: 022736265303 Billing Address: Mailing Address: Map ID: :3.3 ]UDI7H DIRKS JUDITH DIRKS Municipality: (022)TOWN OF RADISSON 3205 33RD AVE 3205 33RD AVE STR: 526 T38N R07W ELK MOUND WI 54739 ELK MOUND WI 54739 Destription: PRT GOVT LOT 3 I� Remrded Acres: 0.580 r Site Address * indicates Private Road Calculated Acres: 0.629 3076N WHITE PINE LN ' RADISSON 54867 Lottery Claims: 0 First Dollar. Yes U Property Assessment Updated: 8/9/2017 Waterbody: Chippewa River 2023 Assessment Detail Zoning: (A-1)Agricultural One ESN: 426 Code Acres Land Imp. G1-RESIDENTIAL 0.580 22,600 27,300 �� Tax Districts Updated: 2/6/2007 2-Year Comparison 2022 2023 Change 1 State of Wisconsin Land: 22,600 22,600 0.0% 57 Sawyer County Improved: 27,300 27,300 0.0% 022 Town of Radisson Total: 49,900 49,900 0.0% 576615 Winter School District 001700 Technical Colle9e ��Property History .� Recorded Documentr Updated: 8/14/2023 N�q WARRANTY DEED Date Recorded: 10/13/1988 211260 WARRANTY DEED Date Recorded: 8/1/2023 445683 TERMINATION OF DECEDENTS INTEREST Date Recorded: B/1/2023 44 2 https:l/tas.sawyercountygov.org//systemlframes.asp?uname=Eric+vyellauer 1l1 'tir � ; � �� 9 ' . '�,w 'Y �� f '..y a r+� ti �r?'� ri ..�� r\ . ..R� . .w ` �� .� • , I � _ » . ' _.-.r ".— �y�dA+ * i i{ �. '` c � �'�j'�,y .�. 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'��. `•tiy �",i.. �� -ti' �� •�� .. -. � . . � 1 } � X a , � '�-� a� � ` tStit� �f , .t �fM� P � . . ti r� , � � .� y �� f i � � . �4 , JJ� .,y r � _ � , M � C�i � "A..:� I '3 . 1 � �� 4 bv � 1 �:5 � J�� ♦.. �;�' �. , ",�.: ... .. . . . . . � � _ ,p '�,��. � �.` � „"`"E�; PRIVATE ONSITE WASTE TREATMENT county �.. ��A& ,��, SYSTEMS -' � Ps ' ( POWTS) Sawyer -,, � �°'�� INSPECTION REPORT sanitary Perrnit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 3 "�S � Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 1�.04(1)(m)] Perm older's Name: ❑City ❑ Village Town of: State Ptan Transaction ID#: K �L, `a}'r�, s-c� �-,aY p��/'cfj ��3s -- Ins BM Elev: BM Description: Parcel Tax No: r�Q �� e �r'F- �.��.� . ��.. o��-��-��-5'3�3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �pp,�' Dosing Aeration Bltlg. Sewer � 4'y,g- ' Holding sk a�pup St/Ht Inlet qy,� ' TANK SETBACK INFORMATION St I Ht Outlet �— TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding }�� fi�o` �'y f�c� � �� Dist. Pipe PUMP 151PHON INFORMATION r Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM ��s.c� e< < o�C"—cQ q-7, I � TDH Lift Friction Loss Sys Head TDH Ft Forcemain L 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�L Bldg Well Waters Q GP � Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other _ _--- __ - -- _ __—__ _ _ _-_-- DISTRIBUTION SYSTEM X Pressure Systems Only L ngthr/Manifold Dla __�L�eng hution Pipe(s) Dia_ ____Spac !' X Hole Size j Spacing _❑Yes atio❑n Ni�pes SOIL COVER -- - --- --_ _--- ----- ---- -- -- - Depth Over Depth Over i Depth of Seeded/Sodded Mulched Cell Center Cell Edges Topsoil � ❑Yes ❑ No 1 ❑Yes ❑ �� COMMENTS: (Include code discrepancies, persons present, etc.) ��,�(f.�,� (�I c� l�.3 � �.T �_� �. -_ —. -- - --- , ---� Plan revision required?❑Yes❑ No b3 ' c� � — J L___ � � - - ��(� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AODITI�NAL COMMENTS AND SKETCH SANITARY PERMIT NUMEER _____ �_�-� S_� _ �� C,�1 i�P'e.....rc I(`�V'�C' �� -�b� �� 2 Q�,�, � , , � �5 �y, ,S� e�c�S A�.,� F � E.\R'J. ,� s' ��p,�. � � y s� ;�,.r �IP , � �-:,��"�� =r�,° � ��1_ v.qH �� e �,,pa 3��b 'r � e��-,�` � �l� }�� (,�1�1�e P�Y,,� L�� cr�°-