HomeMy WebLinkAbout010-941-22-1401-SAN-2022-054 ���'` "'�; Industry Services Division Counry �,�
=� , _ 4822 Madison Yards Way S(a,W e C �
; ._, _ - Madison,WI 53705 Sanitary Permit Number(to be fiiled in b �
•. �_ _ P.O.Box 7162 -
Madison,WI 53707-7162 �,,, ,�j� �« �
- — N
Sanitary Permit Application State Trans=on Number _1
�„
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fortn to the appropriate govemmental unit C�
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailin�
the Departrnent of Safety 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. �,r„ �� _L.
I.Application Information-Please Print All Information
Property Owner's Name Parcel#
: �� "�r� G/o L7c�+n: : E 1� O 1 O -9'� 1 - ol� I �IO I
Property Owner's Mailing Address Property Location
r SS�o W 1�ar L�1 Govt.Lot
City,State Zip Code Phone Number
s� Nc �a
�G. Af a w= y^� .lyl�_'/<, .�w '/a, Section___�_�
II.Type of Building(check all that apply) [.ot# �p� � T �/ N R d� E o
�I or 2 Family Dwelling-Number ofBedrooms y Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
cs�+ � �9�5 ' L
�I'own of I�ra v w a�c`d
+ov��ol'sl+� #'S61a
lIt.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
'a 0 New System �Replacement System Other Modification to Existing System(explain) Additional Pretreatment Unit(explain)
C`h�0.
B' � Holding Tank �.In-Ground � At-Grade gn yp p )
� Mound 0 [ndividual Site Desi � Other T e(ex lain
(conventiooal)
C• � Renewal Before Revision � Change of Plumber
� Transfer to New Owner �st Previous ermit Number u�d Date Issued
Expiration �qAwetG�4 S�N �p-3� �/`f ��
IV.Dispersal/Treatment Area and Tank Information: � �S x �o � c'�// �-.�r CG c�� ct.G-
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sfl System Elevation
Gc� C� !. C. (4�s��� 375'" la�.l �a� � `��-7�
Capacity in Total #of Manufacturer
::
Gallons Gallons Unit� � o 'e �
Tank Information � � U � y
G� �,,,�� New Tanks Existing Tanks � c e� `� Y � � �
T�t N 1G a` U v� � v, v, c7 a
Sepric or Holding Tank 1`O u �, �aQO j
el
Dosing Chamber ��U � $��
V.Responsibility Statement- I,the undersigned,assume respoosibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Si a MP/MPRS Number Business Phone Number
�j.e�+std F�oew.al � -�tSolll 7rS-S58 - I13$
Plumber's Address(Street,City,State,Zip Code)
1 3 SU 1 w �-�-���..�� c�a �4. �,�,ara wz- s�8v
VI.C un /Department Use Only
�A ro ed ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�ti`� ❑Owner Given Reason for Denial $ `�'� �'Z�I ZZ' �'(.(%�.�.c'`r�"�"�2-
Conditions o�ApprovaUReasons for Disapproval �
p t
; �S � �� � �� I ' APR i 9 2022
�� � �
�
SAWYER COUNTY
Lt�}NING ADMINISTRAT�ON
Attach to complete plans tor Me system and submit to the County only on paper not less t6an 8�2 x 11 inches in size
NO RCFUNDS AFTER
SBD-6398(R.03/21) ISSUE OF PERMIT
GeoMat IN GROUND AND DOSING DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE •
Owner Info .. __ � .. , . . ... ...._ _, . , . ,._ _ ,. .�,.
Project Name: s,r.�,; }h Tr� s� - Pa� L�
Owner'sName: Sm� ��. Tr.rsf ��o Dent�;s v�►�•;�h _
Owner's Address: /SSG`/ W l�ac- L n
I�c.ywc.rcl� w � S�'/'dy3
r perty Info _ . . _ _ . ,,
Property Address: l SS G y W /�sr L,n
Sc n�E 5 �J
Legal Description: /�/W '/y S�,J '/y S a 3 T y� N R 09 �
Township 4-{�yW�-� County: Sa�„JYe�
Subdivision Name:
Lot Number: I Block Number: CSM#: Jq(.S
'� C�ukJei� I;.l C8M#i SGI a
Parcel I.D. Number: O►v-4y t- a�, 1 ti o 1
Plan Transaction No.:
Index Pages
Page 1 Index and title Page 9 Plot plan
Page 2 Data entry
Page 3 GeoMat dist. cell drawings&calculations
Page 4 Lateral and cell cross section
Page 5 Management&contingency
Page 6 Maintenance &specifications �ac�,10 p�,�.,,Q, �,-„� � c,�. ��c 9
Page 7 Tank cross sections
Page 8 Distribution media
Gerald Froemel License Number: 950111
Date: 04/06/22 Phone Number: 715-558-1138
Signature: �
Designer S amp: State of Wisconsin Approval Stamp:
Designed Pursuant to the
GeoMat In Ground Component Manua�Ver.June 26,2018 Version
Page 1 of 10
in Ground and Dosing Distribution Component Design
.._ . �;.: .
_ , _ _. : , __
Site Information ` `
R Residential or Commercial Design N ISD Required?
400.00 Estimated Wastewater Flow(gpd)
1.50 Peaking Factor(e.g. 1.5= 150%)
600.00 Design Flow(gpd)
0.00 Site Slope(%)
97.75 Prop. System Elevation (ft)
60.00 Depth to Limiting Factor(in)
1.60 In-situ Soil Application Rate(gpd/ftz)
99.90 Lowest Original Grade Ele. In System Area(ft)
� 100.05 Highest Original Grade Ele. In System Area (ft)
94.90 Limiting Factor Elevation(ft)
0.80 Depth Below Grade
.
Distribution Cell Information
3.25 Cell Width (ft) 1 Number of Cells
2.00 Dispersal Cell Design Loading Rate(gpd/ft2)
2 Influent Wastewater Quality(1 or 2)
Distribution Information
E Center or End Manifold, Dist. Box or Drop Box
1 Number of Laterals System dosed Y ____,
3.00 Lateral Spacing (ft)
8.65 Forcemain Drainback(gal) Does the forcemain drain back? Y ��
0.50 Forcemain Filter Loss(ft)
-- _.
2.00 Forcemain Diameter(in)
53.00 Forcemain Length (ft)
94.65 Inside Pump Tank Elevation (ft)
3.50 System Head (ft)x 1.3
5.20 Vertical Lift(ft)
1.39 Friction Loss(ft)
10.59 Total Dynamic Head (ft) Uesigner must enter friction loss and system demand (gpm)
68.65 Minimum Dose Volume(gal)
25.00 System Demand (gpm)
_ . . __ _ . _ . _ _ _ , . _
Manufacturer Information
Treatment Tank Information Effluent Filter Information
1200.00 Septic Tank Capacity(gal) Lifetime Filter LLC Filter Manufacturer
Wieser Concrete Products, Inc. Manufacturer LT 1/8 Filter Model Number
Dose Tank Information Gallons/lnch Calculator(o��tionalj
800.64 Dose Tank Capacity(gal) 800.64 Total Tank Capacity(gal)
22.24 Dose Tank Volume(gal/in) 36.00 Total Working Liquid Depth(in)
Wieser Concrete Products, Inc. Manufacturer 22.24 gal/in (enter result in cell DoseTankVolume)
Project: Smith Trust-Par Ln Page 2 of 10
in Ground Ptan View
\ `�cell�eoNiat .
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a cu ations
I ft A 3.25 ft Basal Area Required 375 ftl
K 1 ft B 100 ft Basal Area Pro osed 525 ft2
S O.00ft L 102ft
. W 5.25 ft
Basal Area Calculation GeoMat Dis ersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
600 1.6 gaUsq ftlday 600 2.00 gal/sq ft/day
Total 375 ft Total 300 ft2
Pro osed 325 ft
Number of Cells 1 GeoMat Width 3.25 ft
Cell Length ft Lineal Feet of GeoMat Required 92.3
Min. Cell Len th 92.3 ft Lineal Feet of GeoMat Pro osed 100
Cell S acin 0.00 ft NOTE:Min S dimension= 1'
S stem Elevation 97.75 ft
Limitin Factor 94.9 ft
Se aration 2.85 ft 2'Min
Directions:
Play with cell length to get desired cell spacing, length and width Reme�liber system SHOULD be longer than it is
wide. It must also Satisf basal loadin rate and GeoMat cell loadin rate.
Project: Smith Trust-Par Ln Page 3 of 10
End Connection Lateral Layout Diagram
��1 �
;; � .
.,
„� _
_ _ _ : :�
_ _ _ __ ___ _ ___ , � �_�_ __ __ _
. . � �j .J "^�. .
. . .. . ��� U Ll JCl � '�.,
V O O O
i000Q :
f- V,`i �. .� �`v������C!�� --
Hole spacing is every 12", 1/2"hole at 4&8 O'dock,starting 4 O'clodc 6"from end and
8 O'clock Holes at 12"from end.
Lateral Spacing� �(OO�ft Pipe Diameter 2.00 �n
��
n ross . _ ori _ ,
100.05 ft � Finished GnAc Y`�'Y `�'V'`► W V'
I:�`�.,-.: ••�..``....� , 12„�8„ .•eac►fp` Lt�tlL�vd
0.8 ft "— Smd C°�a i°°°mme°d°d
2 in —► PlpeDli _ �t„w ` ,•� ` � . F�
� Ra �:.
Top of geomat to be at o �. - GEp MAT
below original grade � 1 � I � I � 2.A�.33�,�. I � I , I � I � I � CamQoneart
IaSlushve Sorfice
_ _-- �NATIVE.SOIL-� --
� _��_����_._��� _ �,...� L�v:F+�o�
60 ft y
servafion pes , ,
���
�oo.os n �^�^
'�
12"Min. I •���
48"Max. �
sw.
Toilet Flmi c �Rcbar
�Il,^�$. �
�il i�P' -Jl InuOR � ' ,
_. � . . _'_ mts4�e _
pE(1�66A2' �� :`�=
i�i�i i M�M'�QAS��-COLLAR�' �9''�]���y�p����� , f 1 1�i
��Ti i�Tiri�i��'i�i�i�i�i
' � i'AS1M G33�d mde, , ' ' � '
i�iii �i���i�i�i�iii ��i�i i�i���i�i�iii� i�i� i�i�i�i
97.75 ft
Project: Smith Trust-Par Ln Page 4 of 10
Notes/ Maintenance Requirements
MANAGEMENT PLAN
This private onsRe wastewater(POWTS)has been designed,and is to be installed and maintained in accordance with SPS 383,Wis.Admin.
Code,the in-Ground Soil Absorption Component Manual for Private Onsite WastewaterTreatment Systems Version 2.0 SPS-10705-P
(N.01/01). GeoMat in ground Component manual Version 1.
1.This POWTS has been designed to accommodate a maximum daily flow of 60�Q�ns of wastewater per day. The quality of
influent discharge into the POWTS treatment or dispersal component shall be equal to or less than all of the following.
A monthly average of 30 mg/L fats,oil and grease
A monthly average of 220 mg/L BOD5
A monthly average of 150 mg/L TSS
Wastewater shall not discharge to the POWTS in quantfties or qualities that exceed these limits or that result in exceeding the enforcement
standards and preventative action limits specified in ch.NR 140Tables 1 &2 at a point of standards application,except as provided in DSPS
383.03(4),Wis Admin.Code.
2.The owner of this POWTS is responsible for system operation and maintenance.
3.Defects or malfunctions identified during maintenance described above shall be repaired in conformance with SPS383 Wis.Admin.Code,
and the pertaining county Private Sewage Systems Ordinance. The user's manual,provided to the owner of the POWTS includes the names
and telephone numbers of the properly licensed individuals to contact for such repairs.
5.No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Dept.
of Commerce in accordance with SPS.384,Wis.Admin.Code.
6.If the POWTS is replaced,or its use discontinued,it shall be abandoned in accordance with SPS 383.33,Wis.Admin.Code.
NOTES
Two Effluent Filters to be installed where possible 1 to be installed in ST,and or 1 in pump tank in
order to insure particle size less than or equal to 1/8". Filters should be cleaned once in spring,and once in fall. Also,strainers in sinks in
the building shall be maintained,so that solids and fats are minimized to flow into system.
A minimum of 2 observation pipes per cell shall be instatled. These pipes shall be located approximately at the end of each cell.
The plumber,or county shall see to it that a copy of these plans including this page,maintenance folder,and maintenance agreement is
given to the homeowner.
This system may contain a dose chamber. If a pump,float,electrical outage causes the dose tank to fill,the homeowner should see to it that
the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage.
Contact a pumper or your installer if this problem occurs.
The homeowner is responsible for formulating a water conservation plan that will ensure the system is rarely overloaded. I.E.spread laundry
out over time,not 6 loads in 2 hours,while everybody showers,and uses the toilet,ETC.
CONTINGENCY PLAN FOR COMPONENT FAILURE
A.Septic Tank.Any structural failure resulting in cracks or leaks in the tank must be corrected by replacement of the septic tank component.
Leaks in the joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water-
tight.
B.Outlet Filter.The outlet filter shall be replaced or repaired when it is either no longer capable of preventing the discharge of particles larger
than 1!8 inch or when it has become permanently degraded by clogging so as to interfere with the design flow out of the septic tank.
C.Dosing chamber and pump.The dosing chamber shall be replaced if any structural failure is found.Leaks in joints between manhole
risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water-tight.The pump and controls shall be
replaced when they are no longer capable of functioning according to the design plan.
D.Pressure Distribution Piping.Partial clogging of the distribution network may result in unduly long dosing cycles.The ends of the
distribution laterals may be exposed and the threaded end caps removed.The piping can be disconnected on the outlet end of the pump.
The distribution piping may then be back flushed to cleanse any accumulated matter from the piping.It is recommended that the dosing
chamber then be pumped by a licensed plumber.
E.Soil Absorption Cell.The discharge of sewage or wastewater to the ground surFace is strictly prohibited due to the human health hazard
created by the effluent.All failures created by surface discharge shall immediately be reported to the appropriate county.The pump shall
then be immediately disconnected to prevent further discharge to the ground surface via the soil absorption cell.The existing septic tank and
dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorption cell can be achieved.The
replacement shall be initiated only after any necessary plan approvals have been obtained from the
appropriate plan review authoriry and the required sanitary permit is obtained from the county.
Project: Smith Trust-Par Ln Page 5 of 10
In Ground System Maintenance and Operation Specifications
Service Provider's Name Gerald Froemel Phone (715)�58-6472
POWTS Regulators Name Sawyer County SPIA-Zonin�Administration Phone (715)634-8288
Svstem Flow and Load Parameters •
Design Flow-Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow-Average 400 gpd Maximum BODS 30 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 30 mglL
Soil Absorption Component Size 325 ft Maximum FOG 10 mg/L
Type of Wastewater pomestic Maximum Fecal Coliform 10E4 cfu/100 mL
Service Freauencv
Septic and Pump Tank Ins ect and/or service once eve 3 ears
Effluent Filter Ins ect and clean as necessa at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test eriodical
Pressure System Laterals should be flushed and ressure tested eve 3 ears
In Ground Inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap
and are secured in as shown in the GeoMat In Ground Component Manual Ver. March 20,2017.
2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMat In Ground Component
Manual Ver. March 20,2017. Media is covered with an approved geotextile fabric.
3. All gravity and pressure piping materials conform to the requireme�ts in SPS 384,Wis.Adm. Code.
4. Scarification of basal area is accomplished with a rake or other tool.
5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration.
Lateral Turn-up Detail
6-8"Diameter Finished Threaded Cleanout
Lawn Sprinkler Grade Plug or Ball Valve
Box �
Lateral Ends at Last Orifice Where
Long Sweep 90 or Two
�45 Degree Bends Same
Diameter as Lateral
'���`:�">lu_: .
� ; �...
::� � � ,.1� 1 � �
"__'__ ... � ...i_:t....l _�._'"____..
Distribution Lateral Lateral Cleanout
97.75 Feet
Project: Smith Trust-Par Ln Page 6 of 10
PAGE40F5
GRAVITY-D�SED
SEPTIC / PUMP TANK SPECIFICATIONS
4.��e�,�;� (No Scale)
>10 ft from
Building Electrical must comply with '
12"Min.or 2.0 ft above COMM 16 and NEC 300
Established Flood Elevation Weatherproof Eutend manhole riser as necessary.
�H���� JuncGon Box
Approved
Vent Cap APP�ved Locking Manhole
IMPORTANT: wicn wam��y�a�i Accacned
(�YP��O
Anchor tank(s)as necessary Conduit
pursuant to SPS 383.43{8)(g) a•Min.or 2.0 ft above
Established Flood Elevation
(typicaq
�AiAight Seal '
Finished Grade
Quick Disconnect
CAPACITIES .. 1s"Min.
@ �.a y gal�n �:: � . y . . ctiP��q
a �Depth(in) Volume(gal)
A 18 .9 y a�,3 y * �P �-APProved Joints with
�IqUld Hole APPr Sol�'�dPGraind�
B 2'0 4y•y 8 A Depth Force Main «'P'��
�C� 3. I (,, g •9 y � Filter*
D q�ar,,, � *Install and maintain pursuant
�a•� a G(� .8 8 �8 � to manufacturer's instructions.
* _ � c � PUMP-OFF
Pump Tank Liquid Level - in � PUmp ELEVATION = 95 .G S ft
off •
° INSIDE BOTTOM
Force Main Diameter= 01 i� Concrete
. . . , B1oa1c ELEVATION = �y•L S ft
. . . . . ..
Force Main Length = 53 ft 3"Approved Bedding Material Beneath Tank
Force Main Void Volume = $ .fc y gal
[C] Total Dose Volume TDV = �$ , 9�-J gal/dose
(<0.2X design flow+force main void volume)
Vertical Lift = � 3 S ft
Co t�a 0
PUMP TANK: SEPTIC TANK(S):
Volume = $ QO. (,Y 9a� Total Volume = � �,.C�O gal
Manufacturer: W� �5 � Manufacturer(s): W�S�
Pump Manufacturer: 7_�1 � e �`
Install approved force main filter pursuant to
Pump Mode�: L31Us3 manufacturer's instructions.
(See attached pump curve.)
Controls/Alarm Manufacturer: S�E (Zh�r+�.b.�5 Filter Manufacturer: S;m�c�h
Controls/Alarm Model: Tw�.IL. A (�� EZ
Filter Model: S�-F 1 C� O
Float switches containing mercury are prohibited. F
.—
GeoMat Distribution Cell Media Layout '
� 3,25 �Cell Width(ft) 2.63 Sidewall to Lateral(ft)
S�`S Distribution Cell Cross-sectlon Arrangements
� - . __ ._ _ _ _ _--
_ ..._- _.__ S
'_ omponenf eSen _. _ . ._, _. .
O Distribution Pipe
GeoMat is covered with approved geotextile fabric as per the their product approval.
Distribution Cell Plan View Layout-Typical
3.25 Ceil�dth-A(ft) 100.00 Cell Length-B(ft)
-�„d Con,�ecPo���-�re��a'Layout Diagram
_ _ _. . _ _ _ .. _ _ .. __ . _ _ ___. _ ..
r� ..r. �..� r.. rr_w a.r.►/���ar� ...�. +..r.�l
�h.�1�.�� .�� . ��� Y A� ����I#�� !-�V �r��
�t'
Typical ispersal Ceii
Finishcd Gr.+dc '�`+'` \�r `t '+ �7V'V'
I�:`�'��. �.•�_ -••,:.:�..`;-•'.�' �'`'� .Aackfi0�` L,iaGlill,�CY'�
S+md Co�teeommeaded 12"-48" ` ,
pipe� . �u�� � _ . • F�
, . . .. •� Pipc 1�_— —
. . . ._..___. .
,.1` _ - - ..; _� GEO MAT
� � � � � � � 2'ASTM 33�� � i � � � � � � � �
� _ —— �l==�=�=��—— _ = J.nfiltrative Surface
_�{ -NATIVE-SOIL-_ -
1 =��—� — ����_....��_ _ ��� Lir^-4Sapfaaot
t
See de[ails on page 4 tor number,size,and spacing of laterals.
Project: Smith Trust-Par Ln Page 8 of 10
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� TOTAL DYNAMIC HEAD/FLOW
� W PUMP PERFORMANCE CURVE PER MINUTE �
MODELS 53/55/57/59 EFFLUENTAND DEWATERING •
0 6 2o MODEL 53/55/57/59 .
�
= Feet Meters Gal. Liters
U
� 15 5 1.5 43 163
z 4 10 3.0 34 129
>- D.
0
Q 10 15 4.6 19 72
o �9897 Shut-off Head: 19.25 ft.(5.9m)
2
5
3 7/8 6 3J16
4 5J8 1 1/2-71 12 NPT
Q
10 �30 40 50 �
GALLONS ° 3"�
LITERS 0 80 160 -�
FLOW PER MINUTE �O
a
�
CONSULT FACTORY ' i
FOR SPECIAL APPLICATIONS �
�
• Variable levei fioat switches available.
i i
•Variable level long cycle systems available.
• Available with special cord lengths of 15', 25', 35'and 50'. i
• Alarm systems available. , i
,o v,s � !
• Duplex systems available. !
i
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i
3 3/32
� � SK856
Sin IeSeal Comro� Selectwn ustln s SELECTION GUIDE
Model Volts Phase Mode Amps Simplex Duplex CSA UL 1.Ir�egral float operated mechanical switch,no extemal contrd required.
M53155&M57159 115 1 Auto 9.7 1 — Y Y 2.Single piggyback variable level float switch or double piggyback variable level
N53155 8 N57/59 115 1 Non 9.7 2 3 or 4&5 Y Y fl0at switch.Refer to FM0477.
'BN53 115 1 Auto 9.7 • — Y Y 3.M2CheniCal aftertlatOf°M-Pak"10-0072 Of 10-0075.
•BN57 115 1 Auro 9.7 ' — N Y 4.See FN10712 for correct model of Electrical Altemator.
'BE53/57 230 1 Auto 4.8 ' Y Y
D53/55&D57/59 230 1 Auro 4.8 1 y y 5.Variable level oontrd switch 10-0225 used as a control aCtivator,with Electrical
E53155&E57159 230 1 Non 4.8 2 3 or 4&5 Y Y Altemator(3)or(4)float system.
'Single piggyback switch included.
o c�unoN
ForinfomiationonadditionalZcellerprodudsrefertocatalogonPiggybaCkVariableLevelFloatSwitches,FM0477; AII installation of controls,protection devices and wiring should be done by a quaufied
ElectricalAltemator,FM0486;Mechanic2lAltemator,FM0495;SumplSewage Basins,FM0487;and Single Phase licensed electrician. All electrical and safety codes should be followed including the
Simplex Pump ControVAlarm Systems,FM0732. most recent National Electric Code(NEC)and the Occupational Safety and Health Act
�OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
--- --- MAIL T0:P.O.BOX 16347
` LouisviNe,KY 40256-0347 Manufadurers of..
� SHIP T0: 3649 Cane Run Road
Z� �� � Louisville,KY 40211-1961 �rrP��SNCE/9�9�
www.zoeuer.com
P!/MP !O. (�2)7 FAX(502)774�-36248-PUMP
�Copyright 2006 Zoeller Co.All rights reserved. ��� !� �, �r--,
�
Soll �Fro�'ile Sheet � �
Owner: �h�i S S��`�'� . Soil Tester. 'Me��., �Iq�C, �
, '
System FlcYation: a�•�� Load Rate; ��b Systern Range: �'lA to ``$'S
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� �' `':�;> PRIVATE ONSITE WASTE TREATMENT county
�`'�j'D S p \\\�,
, SYSTEMS Saw er
��� !`�� ( POWTS) y
�,
�"FFss'""—�/ INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �.� ,_ 6S-y
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village �J Town of: State Plan Transaction ID#:
�i+n i� �� a �,►r4c-� .��
Insp BM Elev: BM Description: Parcel Tax No:
��.� �W ��- o��h�. .��� �,���-o�� d �►�-9�� — �.2� i�o i
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELE�
Septic �,�,��� _ a,,,00 Benchmark �j, �(� ' �03� l6 � (oo,a�
Dosing ^co,.,,r�p.o g�
Aeration Bldg. Sewer �,$ � , r
Holding St/Ht Inlet S'',�(,1 � �-1,7 �
TANK SETBACK INFORMATION 5t I Ht Outlet S,7 ' q? �
TANK TO PIL WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic �� �a� .}��` � NA Dt Bottom g�$� `j`{�36'
Dosing « << <. �� NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe �j,,3 � � $.$6�
PUMP I SIPHON INFORMATION Infiltrative �
Surface S 6� 5'7,YQ�
Manufacturer Demand Final Grade
Model Number �.g GPM C- �f.6'7� ��-Y4�
TDH � Lift Friction Loss Sys Head TDH Ft
Forcemain L �Np` Dia a.° Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W .2 � � �o z� #of Ceils Type of System Distribution Metlia Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �,��Q.fi
P I L Bldg Well ❑ IGP ❑ Chamber
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO a-a..�- }� -►-� �-$�' ❑ Mound �' Other
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes �
Length Dia Length Dia Spac Spacing ❑Yes ❑ No
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoil �Yes ❑ No ❑Yes ❑ No
COMMENTS: (Inclutle code tliscrepancies, persons present,etc.)
�����.� �(31�-�
Plan revision required?�Yes� No �� �l 23 � , � ��� �� �
Use other sitle for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT Nl1MBER: �o� ^DS f
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