HomeMy WebLinkAbout032-538-04-2305-SAN-2022-037 :,��:�`"'"?�: Industry Services Division County
= 4822 Madison Yards Way SC',(GJ ���
� ,�� = Madison,WI 53705 Sanitary Permit Number(to be filled in by Co.)
�: P.O.Box 7162 �.
__ - Madison,W I 53707-7162 1p 3 �D.Cf L� �
Sanitary Permit Application State Transaction Number '
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �
is required prior to obtaining a sanitary permit.Note:Application forrtts for state-0wned POWTS aze submitted to Project Address(if different than mailing address) Q
the Department of Safery and Professional Services.Personal information you provide may be used for secondary �
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. ] i / / ) J
I.Application Information-Please Print All Information LI�g�� N �� �W w
Property Owner's Name Parcel#
K�1-�-}, -�,�� 03� s3� ��t :��«�-
Property Owner's Mailing Address Property Location �R"�',
�S C�.,�j � S� /� l�L � Govt.Lot
City,State Zip Code Phone Number
J�� '/<, N� '/a, Section. L�
� Cf�.�ss� (,v.1 s��n3
11.Type of Building(check all that apply) Lot# � �r � N R � E o W
�1 or 2 Family Dwelling-Number of Bedrooms � i Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑Sta[e Owned-Describe Use CSM Number ❑Village of
33 ��r #� /�� �Town of ��i (lt�'��
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i
a licable.
.A.
❑ New System Replacement System ❑ Other Modificafion to Existing System(explain) ❑ Additional PreVeatment Unit(explain)
B' �Holding Tank ❑ In-Ground ❑ At-Grade g yp p )
❑ Mound ❑ Individual Site Desi n ❑ Other T e(ex lain
(conventional)
C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner �st Previous Pertnit Number and Date Issued
Expiration I l-� 'J ��)� � �'i ���
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(st) Dispersal Area Proposed(s� System Elevation
���� I�11�. N r� !�I H rl ��
Capaciry in Total #of Manufacturer
Y
Tank Information Gallons Gallons Units � � v � �
New Tanks Existing Tanks � o �, � Y � � �
a. U v� ti v� i,. c7 a
Septic or Holding Tank '1�J Li.T ��, 1 S y�� y
a( i 1 ►, f� �e �ct 5� i�
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume respoosibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumbfe �Signature / MP/MPRS Number E3usiness Phone Number
���, , �t�r� "'07 C�t�.� `� S��'1 ,�����l U 1�S ����._��SJ`/�
Plumber's Address(Street,City,State,Zip Code)
5���`t- l� ���r� ��� T'�? ��� ��1�e�, (,t-� �S`l��`!�v
VI.C unty/Department Use Only
� p o� ❑Disapproved Permit Fee Date Issued [ssuing Agent Signature
�"`� ❑Owner Given Reason for Denial $ ����� �- .[�-d C�%�l�/�Q,d�
Conditions of Approval/Reasons for Disapproval
...�_,.-�—�._.. D �C� 5�'�,?5�?��;-,1(�
;,►N�i � � 1
6r"j �i - — --- -- f;
O� �� P� �A� � , ���� .
GI
��
L
_______ _ .
SHUVY�;�3 �;,,;:;.. :;
ZONING ADMlNISTRr:t lGIV
Attach to complete plaos for Me system and submit to the County only on paper not Iess than 8 in:11 inches in size
, NO REFUNDS AFTER
SBD-6398(R 03/21) ISSUE OF P6RMIT
Sawyer County Zoning & Conservation Administration
````"�`t 10610 Main Strcet,Suite 49 .
� . 1� Hayward,Wisconsin 54843
� �� `� .��� (715)634 8288
� , � PAX(715)63A 3277
/ -� 1��� `�� tc�,ti s i��� i1i3 ilt�,y'I�
� � � "�`' - i F.-mail ui�� :,i� i?� �� ,rc
/ �
--
- � _ � � � _ __�
�� = Toll Free Courthouse/General Information 1 877-699-4110
t �
''��\������
Holding Tank Approval Checklist
1. Sanitary Cover Sheet Date Stamp �3 / 3 ( / o��'�
Parce] ID# o � 2- S 3 Q -D �f -,�L 3 0 S
lI. Plot Plan
�Property Lines _�Benchmark BM ♦
�C Site Address _�North Arrow
� Structure _1 Scale
�(Well �<25' to Service Road
�o Legal Description —�Nearest Road Intersection
� Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans
�Index Page with Original Signature
�Management Plan/Contingency Plan
�Servicing Contract
�Holding Tank Agreement form
IV. Holding Tank Specifications
�Cross-section—Manufacture, Gallons: �� �,CSU4
�Tank Anchor Calculations [SPS 383.43 8) g)]
�Locking device, chains/locks
�Alarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and
State Statutes 101.862(2) and 101.862(3)
�3" Bedding Material < 1/2 "
V. Holding Tank Plans per Component POWTS Manual
�Version 2 SBD-10855-P (R.3/07)
Owner: _�� � Plumber: ��
Application Review Date: �-� �3 ( l �-�� �
POWTS Reviewer: ��,�
Namc �Q ���
t
Liccnsc#
Revised 4/11/2013
C'��RCre�e HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project County Rd W South
Owner Kathy Thiede
Address 2505 1 st Ave E
Lacrosse Wi 54603
Legal Description PRT SWNW S-4 T-38-N R-5-W
Township Winter County Wi
Subdivision Name Lot No. 1
Parcel ID Number 032 538 04 2305
Plan Transaction ID Number
Index and title sheet Page 1
Holding tank specifications Page 2
Site plan Page 3
Maintenance and contingency plan Page 4
Designer Crai Thom son
� � I
Signature �,, �` `'`�L�SEn Phone No. 715-266-2842
License Number 220810 Date 03/29/22
Designed pursuant to:
Holding Tank Component Manual For POWTS (Version 2.0)
SBD-10855-P(N.03/07,R.01/12), � ,
Version 7.0(11/12) Page 1 of 4
HOLDING TANK SPECIFICATIONS �
� 2 �Number of bedrooms
200.0 Non-residential estimated flow(gpd)
2000 0 Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity(gal)
Skaw Pre Cast Tank manufacturer
2000 Tank model number
Tank Alert �' Alarm manufacturer
101 {� Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
49.0 Liquid depth below inlet invert(in) 16100 Ibs Weight of tank
8.0 Maximum depth of soil cover(ft) 1.10 Safety factor
152.0 Length (in) 10578 Ibs Weight of anchor required
�75.0 �,;,��, �h }'Outside Qimensions
,� (in) 16.0 in Soil cover req. for anchor, or
2.6 yd3 Concrete counter weight
HOLDING TANK CROSS SECTION
manhole cover with
locking device and
vent finished junction �—Warning label
� grade box —.�
cap
12" min. � F 23" min. � 4" min.
,..,�_--
-� conduit� tether T
vent pipe
weight 18" min.
blind Note: All tank joints,
� W
plug and joints befinreen ----'-"---
to seal tank openings and 12 in� building
piping are sealed service sewer inlet
outlet Water tight. Pipe and
vent materials comply
with SPS 384. 37.0 in.
Manhole and vent locations Electrical is as
may be reversed. per NEC 300
and SPS 316.
3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy.
Because of this tank's rounded surface,soil cover alone may not be adequate to prevent flotation.
Project: County Rd W South
Transaction Number: Page 2 of 4
HOLDING TANK SITE PLAN
Project: County Rd W South
N Legal Description: PRT SWNW S-4 T-38-N R-5-W
�_� Subdivision Name:
Scale: 1" =40 ft Parcel ID: 032 538 04 2305 Lot No.: 1
�
�--
�
r
�o
v
W"1 Sv1'I�I
:��l
�����5\� um� L��
�� �--�
�
� y° r U� .�{:�
C� J`�
�� ��.
` ���.� N,1.
Transaction I.D.: � Page 3 of 4
t3m= )��, � s� c�r��-�- �� ��.(�2��- b��r� o� 5;�`,�
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 Wi County Sanitary Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 80.0 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 activates), the pumper listed in the current Servicing 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 from this hold-
ing tank to the ground surface, including intentional discharges and discharges caused by neglect, consti-
tutes 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). Connection 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 should be contacted:
a. Installer............................... Don Thompson & Sons Exc LLC Phone: 715-266-2842
_�_
b. Service Provider..................... North West Sanitary Phone: 715-943-2650
---
c. County Zoning or Health Dept. Sawyer County Zoning _ Phone: 715 634-8288
11.
__ - _ _ _ __ __ _ _
Project: County Rd W South
Transaction Number: Page 4 of 4
HOLDI�G 7'.�\K SER�'ICI�G COV"I'R:1CT
Contract Datc: _i�/ ��� � .
This contr:�ct is macic bct+�ccn thc Holdin� T:�nk O��ncr and thc Pumper.
Hofdin��T�ank U�vncr's Name: I'umper's Rame:
����� `�( i��Q� Northwest Sanitary, Inc.
� �� PO BOX 155
Radisson,WI 54867
Parcel Itlentif'iC;�tion 'Vumber:
(f 2 Di,�it Le�acv 1D) �� �-� ���-��-� 3 V �-.�
I. Thr o��ncr a�,rccs to filc a copy of this contract ���ith thc go��crmncntal unit, Sa���ycr Count�.
�.��hich has acccptcd and rccordcd �vith ihc Officc of thc Rc��istcr ol�Dccds. thc\�Tainicnancc
A�zrecment for a Holdin��Tank required wider the Sa�i-��er County�Pri�-atc Sc�va��e S�-stem
Ordinance for the isst�ance oFa Sanitary• Permit for the installation oi�a Iloldin��tank(s).
�. Thc o��ncr a�rccs to har� thc haldin�� tank(s) scr�iccd by thc pimiPcr and ��uarantccs to
��eriliit the pt�mper to ha�c access and to enter upon tlle property for the purpose of ser�-icin��
thc holdin`, tank(s). Thc o��mcr a��rccs to maintain thc all-�t�rathcr acc:css road or dri�c so
that Ihc ��umper c,tn scrricc thc holdin�� tank(s) �ith thc pumpin�cquipmcnt. Thc o�vner
li�rthcr a�,rccs to pay thc Pumper for a char��cs incurrcd in scr�icin�� thc holdin�,tank(s)as
mutuallv a��rced u�,on by thc o��ncr and pumper.
�. �l�hc ptunper a��rccs to submit to thc Go��crnmcntal Unit, Sa��ycr County, a rcpoi� lor thc
scr�icing of thc holdirt�tankjs) as rcquircd undcr SPS ��3.». Vl'isconsin ,administratil c
Codc and the Sa«�-cr County Pri��atc Se�;�age System Ordinance. The pumper further
���rees to ii}clude the follo��-in��in the report:
a. �I�hc name and a�-ldress of the person responsible ior sen-icing the holdin��tank;
b. Thc namc of thc o«•ncr of thc holdin��tank;
c. Tlic sitc address ol�thc holdin��tanl::
d. Thc date thc holdin�:tank��-�s ser�-iced; �
e. Thc ��olumes in ��111ons ol�the contc�lts pumped from thc holdin�� tank for each serrici�l<,:
f. 7'he disposal sites �o�,�hich the contei�ts i'rom thc hoid�ng tank �verc del���ered.
=�. This agrccmcni �rill rcmain ii1 cCfcct w�til thc o��'11Cf OI"�UI11�Cf 1C1'1T11I111CS IIIIS COl1LC1Ct. Ifl
lI1C C�'C111 OI 8 C}l�tl!?C IIl IIIIS CORU'1C1,lI1C Ob1't]CC fl�CCCS l0 GIC 1 CO�)y OI Allti' C�1111��CS l0 1E11S
scr�icc contract or a copy ol�a nc���scr�icc contract ��ith Sa��ycr Count����ithin tcn (I t)?
busincss�lays l�rom thc datc oCchan�c to this scr�icc contract.
O�+�ncr'� �lamc: (Print} (�\�'I1CC S SI`.�,1181Uf1: (()nk anc m�ncr sitinaturc rcyuired)
��} t'h,� �,'.L�r� �a:��-u� e�-�-��-e�
Pumper�s tiamc: (Print) Ptnnper's Si�anaturc:
Ronald L Vieceli,owner Northwest Sanitary,lnc �
G,
Pumper�s Rc�,istration Numbcr:
#2389
Rcc.0 5'�(,r 13
I
t
�
I l I,IIII'�Illlilll�l�lll I I I
-USE BLACK INK ONLY- � �`� � i .V ` � �
POWTS MAINTENANCE AGREEMENT Tx:40.�'ru69
For Holding Tanks 438391 ,
PAULA CHISSER
Owners Name(s)as shown on deed: REGISTER OF DEEDS
SAWYER COUNTY, WI
,f '� • �/ 03/31/2022 09:54 AM
+� RECORDING FEE 3Q.00
Parcel tdentification N mber. �
(12 Digit Legacy ID) � J � - S 3 �- c �- �� 3 � S
— — PAGES: 2
Legal Description of Property:
-SEE ATTACHED SHEET-
We acknowledge that appiication is being made for the instailation of a holding tank(s)on the
property described on the attached sheet.
Retum To:Sawyer County Zoning and Conservation Administratlon
10610 Main St.Suite 49,Hayward,W154843
As an inducement to the County of Sawyer to issue a sanitary permit for a holding tank on the above-described property,the owner is
responsible for the operation and maintenance of the holding tank,locking device,alarm and access,and agrees to conform to all
applicable requirements of SPS 383,Wis.Adm.Code relating to holding tank management,indudi�g the following:
1. The owner agrees to contract with a person who is licensed under Ch.NR 113,Wis.Adm.Code,except as provided by
Section 281.48(3)(d),Stats.,to have the holding tank properly serviced and to file a copy of the service contract with the
governmental unit. The owner further agrees to file a copy of any changes to the service contract,or a copy of a new service
contract,with the govemmental unit within ten(10)business days from the date of change to the service contract.
2. The owner agrees to contract with a person licensed under Ch.NR 113,Wis.Adm.Code,who shall submit pumping reports to
the govemmental unit in accordance with SPS 383.55,Wis.Adm.Code,for the servicing of the holding tank. In the case of
exemption under Secdon 281.48(3)(d),Stats.,the owner shall submit the report to the govemmental unit. The govemmental
unit may enter upon the property to investigate the condition of the holding tank when pumping reports may indicate the
holding tank is not being properly maintained.
3. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent
or abate a human health hazard as described in Section.254.59,Stats.,the governmental unit may enter upon the property
and service,or cause the tank to be serviced. Pursuant to Section 145.2�(4)Wis.Stats.,a govemmental unit may assess the
owner of a private sewage system for costs related to the pumping of a septic or holding tank.The charges will be assessed
as prescribed by Section 66.0703,stats. The owner agrees to pay all charges and cost incurred by the govemmental unit for
inspection,pumping,hauling,or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate
any human health hazard caused by the holding tank.
4. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems
certifies that either a soil absorption system that complies with SPS 383,Wis.Adm.Code,or a municipa!sewer serves the
property. In addition,this agreement may be cancelled by executing and recording said certification with reference to this
agreement in such manner which will permit the existence of the certification to be detennined by reference to the property.
5. This agreement shall be binding upon the owner,the heirs of the owner,and assignees of the owner.The owner shall submit
the agreement to the register of deeds,and the agreeinent shall be recordad by the register of deeds in a manner which will
permit the existence of the agreement to be determined by reference to the property where the holding tank is installed.
-Onl one owner si nature re uired- ACKNOWLEDGMENT
Owner's ignat re: State of: v'���,�ns��
l Counry of: �_� ��(�,��
Owner's ame( rint): Subscribed and sworn to before me on this
� �_day of , 20�
Date: Owner's Name):
3— � S �� '� � E P ublic Signature:
Drafted by: � / � Pu ry Name( ' . .
�"`�"" =� O� i ion expires on: ��Q �, -2�2-2—
* TA�1� *
C�ca., q —C�, o,.� �s ar► pUBLIC
Personal infortnation you provide may be used for secondary p (Privacy Law,§ (m)] Rev.03/26/13
9�O� W`SG��
That part of the Southwest Quarter of the Northwest Qua�•tex (SW 1/4NW 1/4), Section
Four (4), Township Thirty-eighfi (38} North, Rar�ge Five {5} West, located in �he Town
of Wit�ter, Sawyer Colinty, Wisconsin, more particularly described as Lot One (1} as
recorded in Volume Thirty-three �33) of Certified Survey Maps, page 69-70, Survey
No. '1963 as Document No. 389522.
�Real Estate Sawyer County Property Property Status• Current
Listing � �
Today's Date: 3/14/2022 Created On: 3/5/2014 10:58:51 AM
Description Updated: ll/24/2020 Ownership Updated: 8/5/2021
Tax ID: 41756 KATHY THIEDE LACROSSE WI
P�N; 57-032-2-38-OS-04-2 03-
000-000050 Billing Address: Mailing Address:
Legacy PIN: 032538042305 KATHY THIEDE KQTHY THIEDE
Map ID: 2505 15T AVE E 2505 1ST AVE E
Municipality: (032) TOWN OF WINTER �CROSSE WI 54603 LACROSS� WI
STR: SO4 T38N R05W 54603
Description: PRT SWNW LOT 1 CSM
33/69 #7963 Site Address * indicates Private Road
Recorded 4782N COUNTY HWY W W�NTER 54896
Acres: 5.010
Lottery
Claims: � Property Updated: l0/10/2016
First Dollar: Yes Assessment
Zoning: (F-1) Forestry One 2022 Assessment Detail
ESN: 428 Code Acres Land Imp.
G1- 5.010 11,300 23,700
Tax Districts Updated: 3/5/2014 RESIDENTIAL
1 State of Wisconsin
57 Sawyer County 2'Year Z021 2022 Change
032 Town of Winter Comparison
576615 Winter School District Land: 11,300 11,300 0.0%
001700 Technical College �mproved: 23,700 23,700 0.0%
Total: 35,000 35,000 0.0%
Recorded
Documents Updated: 1/18/2010
WARRANTY DEED Property History
Date Parent Properties Tax ID
Recorded: 8/4/2021 433754 57-032-2-38-05-04=2 ����8
WARRANTY DEED 03-000-000040 ��—�
Date 390102
Recorded: 4/24/2014
CERTIFIED SURVEY MAP
Date :3895z2
Recorded: 2/27/2014
WARRANTY DEED
Date 364359
Recorded: 12/21/2009
HISTORY Expand All History White=Current Parcels Pink=Retired Parcels
n7� °k t��� +g♦ I�\" . �� �_ � � # -�� �*�x r*'
� �`�i���e3#�„" : �.`� �s�. a" �•;� Q.-_ •s 5i ' - � _ q. �"aa}" ,� J-.
� ��"'`'r�-'� `���x � '' v � � �'a�� �� -s-
� � ,: '�'� c�� `��0x+�3� °I -e` � �+��' z-
as -�•etrf � � '��� p'" �,7 � �-�.'��i '�.. ^1 �_L�a- f�,�'
S � �i y�2.� Y ,� a„�p' �'S� . �,-ay.,�`. �� �� .� � �' ~ ;
- .�f'Cf 4 �Kr.}4f IA�yq1" .�{3�. '�S � ,��.� . y' k_ _I � -.,h F � k t�.
w �
:. 'y +�'� `��r���'�.��,�v1�.r �� _ 1�,. +,_ � � ��/� �� _ �
u�' .��."'9 �4S r --�..���47'�4�'�{�y�� �~,.^ ya � � � R sv 1r � . 'O �� ��f
'��, ' �" �^ 2z r ��_ ; -�'?:�'!� t-� s'�.� +,
'�. �t�.`A���''�', a,k;-�.��'�� �� ��� _
r - ��'�� r � �dT * �,-� +- d
�- �
y�� r •>J' k�{ •F f � � ,� "'�
S� �+,.'� �"x' �t �.'-^��.-����' _ � �� '� Y�p'�r y s. _ a'�,
r� p � a � �d,� � > � "� ' �'
... � �t y�� � � 4 {�^2'�t �[�c a� . T .T � ��,,
,,{,. ie `� �'�i��34s �s tt `�"`�t� _rt 1-
7. . .' �, ■t '�t- �"` �" S�4 �'"�/$� � y �N -iM .- { o r,} .
t � �.�.���v,�'�. '`: '�.;� A �„���y •, v. ��� �w � _. : � � , ..,
"`T •+Z s�i+'� '= - +`lC��.� �� �ti � i `: .
.�� 'ri ' .y ��_ - � � - .. �" `� .� � 'w"�
.. 1 �. .. �. . �� �. � .i� _
��2 'C-i � � � ' �2A �3�.,, T'�Sr�1�s.y't}. ±''� �. � L y,..�s . '�,� �- .. F . r�
,. ,a�.5 �;"+�"�a�r� �P�'�'1:� r 'ri;-�. Y 3� � *�+�*�F� .Y'�^�'� � �'n', �-'*x.,�'"� �1�� ��y y .,�
}� /'•
!'} 'x �. .4s6� J,.f� M1i> t - d
�^p� �i � � •�.' .� y = •�,�1@��. ��
1 � " .� .��i' � [ � ��F� ��� �- til- 1�'.
9(� �}� _��$$-'„��r ! n y, ,��,t� -f �£'�(��. „,y S+�."�' 1 � t' #
� 5 � �
Y. . 3�'R• '.�'�� �� � �-�:.-h '3���a.t't. �, f� �rF ` ! � � ,
.'�v+ic� � -!� � {� ''C � ' :-s $�-`-` �. �F � �`i.: z�ka�.v,.. .
�} ��,��- 2 .�¢Z�t_ �P �'�'.s.��` .�` '�� ' '}'e y�, pLy�
���'�Y.���i��.�.�rt1�ri ���` �t'a'2.,,� t•+�'+.�#�4���� � ��' :_ � qF_���
� 1 �
, '►* x''�+t'�'• .�.,y�C
� d'�,� .2�y . �� ��.T� x� .,'t-" � `1;�� �r:;
�5`� :�' ,#t st ,�' K" yy i 2 � ; f s,�}�� ` I � ,�
�y° -,����L �+�t`°"�.�`.�.� '. r} �,�'�'+@}'�} �.�r. 2.,'!�� "4{�µ �`�T ,� `� �.�. . .��' -_ -
,
.f:..�r -+�., +�,,, ny��y ., „� .. ��'� r_ - - - :
. h��{�n � ~ •. ".# ! K'• �� +.+'' � -� � -- _ .. �- . .
.. �_-
. .
�,y�� ,�` ^,�,.� ..� � '��` .:.� ; "�,,.� — '� �-'
� �
:�
�
' . •. qTF' ' `i'. .._ ..._�--' — . _ �(R� )C
. ._ .. y ' ' '_ ` ' _
. . J__ _ — � —.__.. . ..- _ .
— — —.'— .__._ . - " � - _
_ -,-�r.
. -_- _ . - �'': '_ � ��r y {/ �(� _
..�, j
l
. ' . ��"1 �1��� �Ft•��y" @ x1CY-y x _
_'�� .�: _ � .�.� .
i� A' .� ba s�+'n � �. f����i��� ,��,, _ ' •,�i ,�'��� j-� � tiK, .y�r.
l _
�
�J� � � 4�.-: y' ��;` � �A �M- b,�JG �-::. j - ��3i �1�,;i � �y�
�., �''Z:S���l'���� ��'��a �����' � � ���.ji [:���t F} , � .
� �._ �J � �
� T".•� � ty` �YfaNk�r... �;,�,.�:3-�y���n�* tl��Y'�r�34.�..:: � _ -✓�-..p ��� ���(� ..� ��(��, ���'r.� � ��r.
��� v�'�r� r � � � �y°4� "��` � � -,;xt "�iy;�, [.�... y. '�'91- .lt� `_ �'� � r
�'� �t ���¢"�_�a`.��'��i't� '1y.,r� T���� r -
.��[t���{,� r J�_ -s;y,����y .�� �A w _ � -•s��i'dv
�� ts���� � ���+�^ ��,.,� :"�{� :�.��" ..=;y,��.d ..YS.''�'� �� { �
-�.,- ���. '�"��.��4�-u+r.��s+. ,a'.�� 4-.!� - ��-+1¢'._ � .F= 3
.r .:`��� :�'�ssd ' �t r Ri`ir�„S�--r .� i 4��*r.:��r�_�• - �gr �� . .; - - � -
.,qp� =a���� '�`4�r ��'s -�. q-. ] . r; "'F',�+ ��$ _ y
: . . • _
_� :
:�`r .�f- y� . ;5 }.'�-�F ,�r. - �, �,*ar {� �y,,�c?>.
�. . � �.� -+4� J}�F�� b �. � � d1�M�` Y'����-� 1
_� . �±I�4 Y . �; 1"f�r ���+ :.-�' . _��•_����' d3�c.+ �'� �� , , ' .
'�f�T.�t Y �7., '�.'�"r Z �vr� �y '$`._'-" ...`. _������y���..�. �'I �c : I'l��.1'r a 1.
S' � `� _ { '.I w t
�kh .�� sd17R1 �". P � . '1'v . . _�� - .. . ' � � �.: N.
3a ' k
•r!a �.u � _ . .�♦ r. �.�/.F ; }�T;, �f . — .._._ ' � - __ _ _ ' � �, ����r 1a' r
�4'�.,�.~ f �"i T�� . I . _ r"„ � • ' f -- `' _
y;�. �S "'�c.,*x c ``�� '*{ �c.a ��� ��i f` - -__ o�-- -i i=- - ��'" , � '
„�"�� �� � � � �s . ._ . __ � -
; - �; ��.. �r�„ � �_ r� ��i f ��
� , I �._ ,�.----�--�-� i
� ..�
����'���,� �`� k� i�� ��fi ������ !�� ;:� � ,i'����!,; _ -�-, ����1 -� i i� ,
� �
A 9l �: � Y
�
ti�
r� �� �
���",.+.� � ��'1 1'�V..r�1t'�t�e��r, `II I��,� . �t. � � I � I � ' +i` ';y'r��i,'
�<•��`�i ��C �4j# T +�j�� �� - � � - �� �I� I I '' �. � �_'s1�=. 's =-
'•���,,,.���,`��.�`�.: d,yt. if�.��.. , ��I�I� � � . �t� r - _ ,,,114� t�-,.+. ,;�, �- �
� -,� ��i4,/��� 7n��.;7� . II-I s �I. � _ c -�.��• III t���i� .�y ',�,t�`
� s-. f��� �'� _?s�'�t'x�j�� I f �) i���l ��' .`•-I r �� S ijP 1
��.r- ;Vs4� }�S..ai``:��� �c?,ti;- ,�,�'3 1��� � '_'� �I __ __� + =—�I ��� ,� d�' � ,�4
�gi�;' ����1F��d"�, •,fTk4"'�..�a'� _ I� II. �`- -.��'✓�.�.5i '� ��� — I� � � . :.� .
„y����i_.;�S . � �..�.�� . `.�---�{� - - � .�
y`.��,� ��x' +�.,}1, 'r _ T � ���-._..-..--.y"�,.,�� �' �
�� _ ,���a�����,rc�`r�t,`+o% ���; i. ..f� *� 'T.— ]�t '�� _ _ �.- . I � ��t ,�; �,,
�A.. ` r ,�+..y�,,, �,. r ._ . . � s� '; -
�� �t - �,y�s�, v ;,#s�� .� 4,. . , � � � ;
'�� �yp� Y
�it�� ��.4'�'�t-5�f�!�`. .0 f(�f�S � _ S� �.�� [.q... .. � . "� `51.��, z�"
� i C .�, . '"r �j v Y ]`r 3 �"-J �F�-r +�
J 4x�'i '3 .:`� ��i�.-�..1Y•.. f}� 4�7��� ice-. �YiY•c r .:atiw� ��! w.'6 �.y �+�' "=ti ;�� r'i 1
n♦ � 't �� �� � �. "'�,� �T�l _ _ �` �l,v� �.�9{�-, � 3 i �' :F iF r'
..� � * � ��i � ,�y� 14t �d � -�� � j � � �� ���)� ��!L�\�����. .� y� - ����t
�y ��{ry.. 4 S t�s i r� 's��A 4 Y r M 1� � c.'�1} �y.� ' C i[S� 'ls aY� �'"�n'�a.
+�` .. .:Y � � 1 ..y, .:h,` : _ ,,:'..e�a."� � rt'�k�� J yZ "� � ��� � "'�' `.
, _ . ► � �. 'e �.:J�,�.,.�b' �_•i,�' i • 'y { .,;� '?� �}`i,r' '4., . �k,. ,.,
. � � + . _ . i �� ' >� f� � . .
-i ly�i.:�� .tk=���t � � �� .������S}t....f ky '� t �y�.
!�� �� ��t �)��- ��•' -- n 'f= - 1':i ' '�{�+- `
.'�:: � ¢ -'�j, . +:k �; :�'�tt�'�`'' �,�•�,y� x i=.�'i"' ,. /'a 4� ��.'�a� �+ ' J: s'. .' .. '��t �" �
���� -.�i�U����.� :?'dy�►r� '9;� .f� � 4� � '��t'�4 ��. y�-. . z,- h ,3i' f .K,�"7ftr�p� � "��-: s `'L" ��:
+� "R yar 'l�� '.F.� �`y,j�'fi��� �-TT �.'t _. ..ly [�- z. #�3�3t. �� - .N. �3.,+�.
� � . � �� }�- �
;�'° �y `� gra '�� 1,�;����i '.� �.f� ,� �� G � :,.. ..,�� }�,X4'+�.s!'y� ,. �� + 'S#.� ..r;.
`� �' ` �a;9 ys� ,�°' ` � v x r s 5 �mtr� ��,��� .� :�� +� � .J .ss
i ,mR
��r_ _ �} !�;� .h�y �. i( l� - ��tir _ %�'�1'��? i. � }�yt*e��' �`�. '� 4
A
��� b �.� 4 :. � .� �� �.� � ��rjat� Y� ��'C
h( � �'��`, . i�t :�� `t# `.-t' '� Y `' s ni`3��� f � #�' r �!y-
�7i��� *� �• �I � ,`4 '� .<_r���� � i� �����q;� � _ � '��
d: '�.,� `.'Y ,:5�.' .�
r 3 ''F t' � {'} '.y' i:� i' �.+'.. u�;. �'��. ..,,+��7�
/'"`''�"""'�� PRIVATE ONSITE WASTE TREATMENT county
'� �c'�
�"�����`s �1 SYSTEMS
\�� ( POWTS) Sawyer
` �\�-PS: ��
NV\__ 4,P
`F=S1"`=' INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �2 �3.�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
1_ ( � \� ` t iN r--
Yl L�,(�•g"' �/
Insp BM Elev: BM Description: Parcel Tax No:
�oo.�' ��- �I�. ��- �� o3a-S�8-o�—a3r�s"
TANK INF RMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark I �� � (d�.�,` (00.0�
Dosing
Aeration Bldg. Sewer Y•,3 ' Qc7, 1
Holding �/ � � St/Ht Inlet t�,7 � 6,��
TANK SETBACK INFORMATION St I Ht Outlet
TANK TO PIL WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man.
Holding .�.�' �3 .�..�3� �2S' Dist. Pipe
PUMP/51PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N L #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO o Mound � Other
DISTRIBUTION SYSTEM X Pressure Systems Oniy
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia _ Spac = Spacing ❑Yes ❑ No �
SOIL COVER
Depth Over l Depth Over Depth of � Seeded/Sodtled Mulched �
Cell Center � Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Inclutle code discrepancies, persons present,etc.)
��.,s���� 6� � �a2
� N�.�.
Plan revision required7❑Yes❑ No �� 2d �3 �---<� 6ct'� �� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL C�MMENTS AN� SKETCH
SANITAAY PEAMIT NIJMBEA: � � G3�
� � _ .
i
� P� 1�'�
-_ _- _: -- .- . _ _;__ � � �°� � . : ----- .--_: - -_ _ - -- __ - - -
, � � �
: .__ . . _ _ _ __: v _ : . _ _ . _ : _ _ . _ _ __ :
;
� �
_ : _; _ . ___ _ }_ ._:_ _ __- : _ � _ : . - : - --__ __- - � .�_+- -- - ------
,
� �
. _ Q�� __ __ _ ___ .
__ . � ► . : , -,_
.
�-` ; , ; .
t �
. � _ . _ . _ � _ ;_ ._ . � , �.._-_- - -
� . .
ax �'�'� � �
/ ��N�i� � R�w �J
\ r / I
��N I�' --�—�-
� � ��o
c�' 4� �s�\���P��.
� iY �
� ,��3m
� ��°°'°
7 �h� �
�,o�w�
�����
-�-
�-