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HomeMy WebLinkAbout024-741-03-2104-SAN-2022-149 '`�"' � Industry Services Division Counry �/� 4822 Madison Yards Way � �U � : _�_' = Madison,WI 53705 Sanitary Perm� umber(to be filled in by = P.O.Box 7302 Madison,WI 53707 �9 ,3 C3 �4� � Sanita� PeY,mlt A„pllCatl�n 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 forms for state-owned POWTS are submitted to Project Address(if different than mailing ^[ the Department of Safety and Professional Services.Personal information you provide may be used for secondary � pueposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. , I.Application Information-Please Print All Information S�j,�,� Property Owner's Name Parcel# IYI� ` � ; da�-��- �-c� --aie� Pmperty Owner's Maihng Address Property Lo ation l� `77 �;�'�`-. Ciry,State Zip Code Phone Number I� , 1T �LQ.�(�� E�'/a,�l�'/e, Section � L��l� W Ti II.Type of Building(check all that apply) Lot# �- � � N R E o W �I or 2 Family Dwelling-Number ofBedrooms � Subdi��ision Name Block# �ublic/Commercia]-Describe Use � ~ �Ciry of �State Owned-Describe Use CSM Number illage of — �"I'own of �,(�(�.- 11e�..�i �+ 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� ew S stem lacement S stem �ther Modification to Existin S stem ex lain Additional Pretreatment Unit ex lain � Y �eP Y S Y � P ) ❑ � P ) �K]I ��V�r> B� ❑Flolding Tank �In-Ground �AAt-Grade �Mound Individual Site Design Other Type(explain) (conventional) C• ❑Renewal Before �Revision hange of Plumber �I'ransfer to New Owner �st Previous Permit Number and Date Issued Expiration ����� � ',7.,3Io7 IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� Sy m F.levatio l �a ` �J`��7�1�-( �� d�`T. Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units � U U „ � � � New Tanks Existing Tanks � ❑ a� " y p _ � � o -� 2 n. U in �, v� v. C7 0, Septic or Holding Tank � Q -lJ���� Dosing Chamber � � � V.Responsibility Statement- I,the undersigned,assume responsibility for instellation of the POW'I'S showo on the attached plans. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone I�umber 5 ��1! � � �l�-5 � Plumber Address Street,Ciry,State,Zip Code) � i 05% � T 9n �r � � VI.Coun /Department Use On1y �Ap� e ❑Disapproved Permit Fee Date issued Issuing Agent Signature ��/ ❑Owner Given Reason for Denial $ ` ��'�o �' I 4/�" ��'��'`^""�I�"��i�-✓_}- Conditions of A rovaUReasons for Disa roval ---' �' PP PP �....r_i4;�,� ., ' , ,� ��1�.�;'��,;�: ,;l' ' � I � �r�� �='�=��;� , �� ' �� �S � �6 - �� JUL 0 6 2022 �'r ZONdNC��M NlB�RATl01�4 Attach to complete plans for the system and submit to the County only on paper oot less thao 81/2 x I1 ioches in size NO REFJNDS AFTER SBD-6398(R.02/22) 13SUE OF PERMIT 7/5/22,8:54 PM Novus-Wisconsin Access rev. 13.1108 Real Estate Sawyer County Property Listing Prove�er smms:c���� Today's Date: 7/5/2022 Created On: 2/6/2007 7:55:41 AM �'Description Updated: 5/26/2017 � Ownership Updated: 2/6/2007 Tax ID: 24774 MICHAEL 7&CNERYL A RILEY HAYVJARD WI PIN: 57-024-2-01-07-03-2 01-000-000040 Legacy PIN: 024741032104 Billing Address: Mailing Address: Map ID: .5.4 MICHAEL]&CHERYL A RILEY MICNAEL 7&CHERYL A Municipality: (024)TOWN OF ROUND LAKE 10881W STATE HWY 77 RIIEY STR: 503 T41N R07W HAYWARD WI 54843 10881W STATE HWY 77 Description: PRT FRAC NENW HAY4VARD WI 54843 Rewrded Acres: 12J48 Lottery Claims: 1 w Site Address *indicates Pnvate Road First Doliar: Yes 10881W STATE HWY 77 HAYWARD 54543 Zoning: (A-1)Agricultural One ESN: 464 Updated:4/5/2021 �J Property Assessment 2022 Assessment Detail � Tax Distric[s Updated: 2/6/2007 Code Acres Land Imp. 1 State of Wisconsin Gi-RESIDENTTAL 1.000 I1,000 113,200 57 Sawyer County G6-PRODUCTNE FOREST 11J46 ll,600 0 024 Town of Round Lake 572478 Hayward Community School District Z-year Comparison 2021 2022 Change 001700 Technical College l,and: 28,600 28,600 0.0% Improved: 113,200 113,200 O.OMo + Recorded Documents Updated: 8/14/2014 Total: 141,800 141,800 0.0% O WARRANiY DEED Date Recorded: 9/5/1991 225093 471/211 (� O MAP OF SURVEY L"4 Property Mistory Date Recorded: 5/22/2017 3417-4 N/A https://tas.sawyercountygov.orglAccess/master.asp 1/1 PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): (Y�.�(;•�'�Cl,f.-� 3�, Z C I'�-. (�i � ' Phone: - - Owner Address: � �J Ul1 S�"� �. 7 7 �c,�Yr.�7�� t�.�,�Zip: 5484� Project Address: Govt. Lot: �1/4 of l�� 1/4, Section.�_, T � � N-R�E ❑ or W,Q Township: �,�� �,�G� County: ��j(;�,t,L7L,d�.�' Project Parcel ID #: ('�n2���� � - (j j —0��0 � Designer Information Designer Name:�Ll� � �(,ZO'� Phone:�l5 -��� Designer Address:l l�, � I`C1��C � Zip: ��"�C.� E-mail: (.c"4�` ('c?� . ,;, . License Number: ���' `� � Remarks: Signature: , ^ Date: ��D'��-o� riginal signature required on each submitted copy. ; ��F�j�---------7 1�'� : L., ; << � �{,' ---� `� � — , �r-�--- _ - -�;: �-- � ��r`�i.;f �� , �� -�.�f�' \,�5 � _ �$� �� - '� ✓�, � � �� �� � ., ,- � � (� � � �� ��� _ Wr�" � � � � ( }GJ` i � � �' r � �v' ' i :� � � ��� ; i � � � � t --------�----�_----- \� , r;° , , A ' � � �%-� f ' ti ,1 � -_r � - � � _ � , - . { 'I ; ,� �� � � �, 'I � � I � �_/ � �`-I - --.__.. �3 � �; j '„'GS"L�f �rI ,/d' 1� � � � � f � # +S � I — f,� _� ._ _ .,,.�, - _ -- - �``--�---.__.�_ � �/'n� --- � � i -^'`__.-_ � i�S "-'�-�„�� i -.�._-�_..,__.� � � __-� -" '�,_-_'"�-�_� `'--__ ` - '�-�__ �-.,`"'_-�--.... � -- --'-- - .- �...����._ ' �----�-�.__--- ----_._.__,��_ a'�-` ���_ . -�. �� '�� ��-��-5' G� 1��� � : �-�-.�� - �-� � ,�, , y, I'' �O� � � �� �� �� M N z��.J� �:l'7 � 1�r � -L�' �It���� hC�t�- �o -- t �i L - h�o�,� Nt� ��- �� a�-�-;-5 M r�-8 0� ��M,L o�+-r�-�-�,Y,�� `` 'p��aint'fros �2; ��I -�y i�� .� '� t�� �1�U ' ���'� �� �NN`�0 � Sc:F�tic Canl;(s) Msmufacturer. IN-GF��JUi�D t�R�UITY DiSPERSAL., AREA —_��Q..�� Uniform Elev�tian Trench�s wi�h EZ12U3H�' �undle� ;��,�;�.,��,nk s Vc�li.irnc 3-ft Trench (down-sizing crPdit) ���/'� � � `:' c�:': ��,e�"�al yal {�al - — —4�a1 �fih�u�il f=iltcar Manufacturc�r: __�L_.�Y---_�'_--�-�-'---�--_.V'__�'_�_�_.._ `�' �'_.._.�'�_�'._. ��' %�C� -- / /'/sLC 5���'-�1Gt'�� I � - �� � ���-- -min.12" f:ffluc;iil 1"iiler Madc�l t1' ��{'����-. C;enta�xtflt: I j ' _ -- + (ty{�fr.�+l) CoVtn _._. --- _.___.,_.____.___�_._ _........__ _..__----______,.�._.__.._..._._.__._._...__. �� - soi�covci. :_.I _: _. TYF'IC/aL TRENCM ,�,�,� ���,,,�:�,- d � . C:f�OSS SFGTION VIFW d��pn, � c�v�,;�:���> _�._ ._, ..,_ __.� �.-�`. : :� (No Scale) o«srrzvnr�oN F�i�r� �r=rn,u.. / «. � (wo sr.;,h,) Systrnt�Ii:vFilic)n/.�L.���`r o 'n "F , ,cm�v��vuoui -- • �. _. Slip C:�ip Qc�a�;u) J�W w• 1'inc�lind G�ad�i �tyr)I����� �71'OVIC�(' Il1I111C1'1U111:� �� (m�dr.lrodY,wnodud) S@�"1F.11'il�l0{l f)f?iwec-;n irr.nches. ���v,��vc���,�,..._._ - ��,��:.�,��c;nver lap ol pip��lo Innnin;dn (fnln.1(au1� :d cn;iUpvn(ml•�hod yU�d�� , (4)1/n"-11j?"X ti'Slut�� - , f,_--. ��Y'���;,�L TRLNCf-I (Shc�w loc;iliun c�f irdc:i/ouHr,l pi�ac r,oruier.fion crn pl:ir�vir,w.) �n+m:�i�:��i ,� �'�,,:.! Ancliann,ry Urvir.q..._..'i '`� f{ Ird�Uiahun PL./1N VIGVV �u� Ob;vrvatiunpipt���ha(Ihuin�;I�diinl '` �;ti:,��:��'«✓'% .iudnc�� �if�uncUun hnlwucn twu uiuL;. �t�:`c.�✓ (hla Scale) �i Perfar�aled Lat�:r��l ot,;en�ationt�ipo -� --- ��YC�icral) (�vrii<:aq (�Yf�Ir,ai>� J"°_: L ""1 - // - - . _..._ ",0 _ _ �. __ _. ... _. _.� . . .__ _ . . I _... _.. �. A ___. _. ..._ _ _..q .-: 3.0 ft � � --_ _ _ � ,.� _ ___.______._ _ _ _ . —� __. i�vt3i�:;il) ' �-- -_ - ,.: ._ � ._� � :. _ ... _. .�f . . ._.__.. __ _ ._ _. �� �_. _�__ _�_ .__ _l I�n � ----.— � -. �� ft -. _.______ ._�_.. __. _ _ . - --___ __ ..__�l c� __. � _.____. ._ __________.. �}vrl;��,�� � INSI"/1LL PER TRENCH: � EZ1?U31-I i3�indl�: -n .______.._._..-------._..._.____._______--- (ty��ir,ai) _. �?,,, 10-ft bundles�c� 50 ft' f::iSAlunit= 3 c�� ft' (rntd by InHitrator Systc:nr.;,Inc;.� `�' Inst�iil p�irsi.iant to mrinufacturnr's liisbucll�ns. -h ,_ „�, 5-ft hundl�s @, 25 fi' EISAlunit=,_.,,.,�,,,w ft' __ _.__._ -—---__------------__ ____---._----____._.___------- �I'rr�posr.c3!-•IS/� pr.r tr�nc:h= „,,,,,,_R____y, fi" I?r.quirrci Iniilirr�tiari/hrr.�a= ,�5�,,�ft' Diskrib�atic�n Mcthc�d: x 4..,,,,�,�,a trencl7Gs •- F'rapc�secl 'T�c�ial F�IS/1 = .��?.�?„ tf` „��;��_� I R�SET F tn-grouna vrav�ty nnanagement Plan IMPORTANT: The owner of this in-ground gravity system shail be responsibie fior its perpetuai opera6on and maintenance pursuant to requiremenfs of SPS 382-384,�sc.Admin.Code. Pursuant to SPS 383.52(2),Vfisc.Admin_Code,this system shall be considered a human health haaard if not mainFained in accordance with this approved management pian. Furthermore,all inspection and maintenance activities shal!be performed by a registered POYVTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. IIIN�a�timum Dis ersai Area Operatinp Limits: Jesign Flow=�_ 9Pd; BQDS_<22U mgL''; TSS<_15Q mgL''; FOG_<30 mgL'� tnsnection Checklist INSPEC7 EVERY 3 YEARS o type of use o age of sysiem .. nuisance fiactors(i.e.odors,user compiaints,etc.) ., mechanical malfunction(i_e.,pumps,valves,switches,floats,etc.) o materiai fatigue(i.e.,leaks,breaks,corrosion,etc.) o solids valume in anaerobic treatrnent tank(s)and any distri6u5on appurtenance(s)(i.e.,disfribution/Brop boxes) o negle�i or improper use{i.e.,exceeding design capacities,prohibited activities,atc.) o e�ent of ponding in distribution cell prior to dosing o dosing irregularitles-�appiicable(i.e.,pump re-cycling,float sr✓itch settings,etc.l o elec[rical components-ii appfica6fe(i.e.,wiring;connections,s�rritches,controls,Gmers,alarms,etc.) o disfribution faterai or iaierai orifice plugging (measure lateraf distal pressure-compare to design specification) o surface discharge of effiuent or sewage hack-up into structure served Mainienance Checklist MAIPITAIN EVERY 3 YEARS{or when necessary? o Se�tic and dose Yankfs)shall be pumped by a ceriir�ed septage servicing operator licensed under s.281.48 Wis. Stats.when ihe volume of solids in the tank(s)exceeds one•third(7/3)ihe liquid vofume of the Fank(s)or as required by locai ordinance. Disposaf of contenfs shall be pursuant to NR�13,Wisc_Admin.Code. o Effiuent tittee(s1 shalf Ce inspecced every 3 years and snall be Geaned vrhen necessary to remove any accumulated solids according to manufacturer's specifrcations. A servicing period wili aiways be greater than 72 months. S}+scem mainfenance reports shall be submitted to the prop�r tocai government unit in accordance with 5PS 383.55 Wisc.Arlmin.Code. Report any componeni failure or maifunction to: Name of individuai or company�(�Q� ��ry Qp� Phone���S"S��'��J73 Locai govemment unii: 11,Q.1� ��h[y, Phone�l�(���Q—��' Locaf govemment unit address'l�Q mQ,�,�'{-Slnl�� ��l���e t/�7IP: ,��'�3 Any defiective part of fhis system shail be repaired,replaced,or removed pursuanf to SPS 383.51(1),Wisc.Admin. Code.Repair or replacemeni of iailed or malfunctioning components shall comply with SPS 383,1Nisc.Admin.Code. No product for chemical or physical restoration oi ihe POWTB may be used uniess approved by ihe departmsnt in accordance with SPS 384,Wisc.Admin.Code. `'ontinqencv P[an in the event fhat any railed treatment component of this PONlTS cannot be repaired,it sha(i be replaced pursuant to a plan submitted to the appropriate agency for review and approvai. A failed in-ground dispersal component may be abandoned and replaced by a code-compiying dispersai cornponent in a pre-determined area of suitable soiis. Svstem Abandonment If use of this POWTS is discontinued,it shali be abandoned in accordance with SPS 383_33,Wisc.Admin.Code. Soil ProEile Sheet Owner. Kil2 SoilTP,ster. �S "SC' ey;o�ci� System Elcv�tion: `�•��� Load Rale: b�`? SB 1 a � System Range;�� ro 401- _ � � � �6a ...... ...... ...... ...... ...... ...... C�j .:.... ...... ...... ...... . ` 1 ...... ...... ...... ...... ...... ...... G8 _... ...... .... ...... ... ...... ..... .. ...... .... a� .... ...... . ...... ..... ...... ._.. ...... ..... ....:. G ... ...... .. ...... :..... ...... ...... ...... GS ..... ...... . � ..._.. ...... , �y ... ... _�ly� � � .. .. ... ... - 9`l,Sb' . ... ...... ..... ...... , .. ...... � -93.S ..... ...... :::::: ::::.: 9 j .... ...... :::: :::::: :::::: ::: :: � a ::::: ::::: ::: ::: :: ..... ...... ? ...... ... . � � ...... ..... .. ... ..... , a ...... ...... . ..... ...... 7 .... ...... .. ...._. ..... ...... .. ..... ..... ...... ... ...... ...... ...... .. ._... �Y.C�r ...... ...... ¢1��k�ly S�S. .. ...... ...... ...... .... ...... � ...... ...... b��l — 89<0 � ...... ...... — , �— ..... ...... ...... .. ... . ...... � N _ � � S � : ::: � ::: .::: -�$� Y�- �� ) ... .. .... � N � +3� ..... ...... �3 . ...... �7 ...... ... _ �-3 � .. ...... � ... ..... ...... � � ... ...... �� - 86 .a � � � ::: '86:s'8 � ��'�Kv2 , , . . � � . .;�.�. �. . . : - _ . -` � � . ..- .r a' �.p;y y �• ;� ?T� l .. °� J��, c �`�+��3�^ I �J r�._ • �'-. � � _ , �`a \ '�� � : • � � *:., \ r, `�_ ,,�"� , � '���- '� r � . ,�.$�� '�; - v' V � q}. . �y� A..,� � Y.M��� .�'j,:��;���w��,.•---� .. .'+L� N t�F�'yi�'3 `�;?�'..^' ��� '� .� *p �:`�y,�.,�E�`� } _ 'f V ."�y^-a,:� �,'`4 l� F��p. �Tr`'t _�rrb? 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"` / � 4 �' '� "`6`. r'_ A c�' {�� � — Y # ` .Y� .�ld ^ �� A`'I � Y � } . �� t,. � � t � ��� � s�, �3 ``�"� 'I / ��c Y.:�,,. n ,r i�� � � k � � � �` �,.".. , , 3 f �1 ti+�K' � � ��+ti. } � , _ w�,.. 1� �� . 1 �� �,.v '��' � ...,. ..� � ..�� �� ' � � � ���"' � . ; �,y�;'�, -� � "__ � .`y �� � �r� �t ,�„ , �„� y, �r ! yy }� r.. ._'!1� t�t}iS�. �,� . . J� r�l� �7'� Y .. � � s,. . � � l�� - ,3�3o U� �M��;: . � � vu�eooraMDapannremofconurmros SOIL EVALUATION REPORT Pape � d.�.� Diviaion otSafety md&xld'vigs — in aaadante wilh Comm 85.Wfa. Adm. Code �ry � amd,mmp�eoe cWa Weo on aa�er oos laaa than e irz«.t 1 v�d+es y�s�e.a�an must Saw e r MiduAe.bW not Iimi6ed b:ve�dcal and horizonkl�ef�rence �� . ' . . ` DdiN(�.dkedion a� Parod LO. Percent slope.scale adimenaiona.nonh armw.and locadon and dbta�co ro naerest road. O� - 7 - O � sl�0 Please print afl lnfom�atlon. R°"'�, �\ � Perton�Ilnfoma6onyouproMdamayMwaOfors�ooiWa�YW�Voaw(PrivaryLaw.s.75.W(7)1m11� �w ��—Z�I—Q PfOpBflY�W118f Pf0{79f1�/�OCB�IOn ' a � 1 A R; e cow.�a E'/� �a N4�Iw s 3 T y 1 N R ~I H� anopeny owners eaatwp ndaress i.ot u sba a s�a. r�ne«c�re O � e 7'1 smm wro�e w,� O c;h ❑w�e �Town Nearest Road t 0881 W c WI ( ) p New conswcuon u�:�r��a�,mi i n��x or ced�oo„�e� cAde ae�d a�noW�am G et� cP� Re�a�d ❑ Fublic or�-oe�cr�e: Perent melB�iel__. �3p c:n 1 T: � ( Fbod Plain elevation it appYcable wr I w R C+BnBtel oanmenla andremmmendatbns: IJen- PresS.+��sed T� - Gco�nd Srs�Kf So: 1 L osd:�g Raa� : o. 7 /�. G yPd ��f � S�,s}cn. Elt.�o.��o�n Raege : SQ.SB �- 4'O .SO� � �� ❑ �9 � P�i cro�na s�nace erev. 4 4. 1'T e. oeam m r�nm�y raaa >�9 _�n. � . � Hor¢an DepM Dominant Redmc Dasctiption Te�Awa S1nxWre Co�rKa Bourdary Raots GPDIIP in. AAu�sell Qu.Sz ConL Color Gr.Sz SM. 'ER61 'ERiZ � 0-44 `— — G L l_ "' — "' a 4-48 � 1 Cca o.7 t.(o 44- J Y � Is J o.� i. � G�-9� '�/� — 3 ..1 l 0. 7 1 . 6 7 5YR S/ � 5 O/ rn 1 � '- o.7 1. fo � �x /❑� �e �l PIt Ground wRxe elev. q3. S 0 ft UeP�a����9 Te���• Soil ' HeOe Mwaon DeptA Uominant Cobr Redox Desaiption Taxhne Struclure Cor�sisMnce Boundary Rooffi GPDAP In. MunaeM Qu.Sz CoM.Cabr Gr.Sz Sh. 'Eil�t 'ERN2 r o•� � —' � L, l. -- _ ` _ > > - s/ l x a � t•c. 3 �- o IOY '�I — IS c5 0.7 I. (. 4 40-3'7 �.sYR r 6 c � 0.'7 1. S 57-7) 7 5YR Y/ ^ C O.'7 1. G a �a-91 ,.srn S� — �a — — a.7 ►.� •EIRuaM#t=BOD >30<220 mgyl and TSS>30<150 mgfL 'EfAuent f2=80D <30 mpll and TSS<30 mglL CST Name(Pkasa Prfnl) re CST IJ�miber � aaG� 88 q� Oak Eve9�ation Canduded Tebphare Number S�A�1 Qo I /0 9 O 7� -G3'! - 6 as0 •AroPertyownar n . c A:►�.. Pa�inroay-�yl •o3. a�ev �e el ot� a BoongfF� ����. r � • r . � ❑ Pit �Ground wrface eiev._4y.58 ft. DepTh ro limik�g factor�f`in. Srn7 tion Rate Horizon Deplh OommaMColor Redoz�Desaiption Te�ea Struc9�e Caniamnoe BaxMary Roota C,PD/R° in. Munsall ' Qu.Sz. Cont Cobr Gc Sz Sh. 'ERRl1 •ER02 1 O-S7 '�..�1. �L — � — — � � Y 3 -� — '- o. 7 1. 4 •3 �-5 1 �'Ry — 1S — �— ' — — 0:7 �. T .�• �'Ry/4 — — `" "_ ," 0.�7. �.. 5 G7- � ?•5vq S/ 5 — � — --� o.-� ' �. 6 � e�;,,9 x ❑ e�'"s ❑ Ph Grwnd wAace elev. � �R. DepTh M Fmiting factor in. Soil ' tion Rete Horiton Dep1h DominemCobr RedoxDesaiption Te�Aure 'SWclure Consistm�oa Baundery Raols GPD/R in. Munseq Qu.Sz. CoM Cobr Gr.Sz Sh. 'EMN1 •EflM2 � �x � �� . ❑ Pit GrouM suAate elev. ft Depth l0 4rutirg factor in. Sail Gcation Rate Hor¢an Deqh Qaminant Colo Redox Desaipfion TexWre S6ucMe Consi�rroe Boundeiy Rools GPD/1F in. Murwell Ou.Sz. Con1.Cobr Gr.Sz.Sh. •EftA7 •ERN2 , _ l� n V272U �; -_---_ "_ � a � •EMuent#t=BOD,>30<220 mplL a�TSS>30<150 mplL 'EHiuent 1@=BOD,<30 mgft.and TSS�30 mglL . The Depar�mrnt of Commcrce is an equal opportuniry service provider and empbyer. If you need essisw�ce�o access services or nced matcrisl in an ekemete fom�at, plcax crntaG the department at 60�26b3151 or TTY 608-264-8777. SOD.UM fR DhM� jI � K 0 MI I N Ql � � / `��b� ,� W X `0 � � 0ya\ O `o � � 0 [] , r, ,: z x !�Q %�� �Z��� / �j� p P LL y � � � t � . \ K r� W �.� \ � —* .—a —.— _r— _'� � r , 3 � w ^ r � y. 1 �- —,, i � � � x y� �� �7 ie � ,•� �•i i d ' i � �i � � z h� I � d � a � � / fa-4 ; ■ r r \ 0 J / `- �..1 k '� W d X^ � � �� � � � ` F ^ i 4 - T � � � d v� � i � W �, �' � ct - > �„ 3 a r � 1 Q � � � T W � �v 3 0 � r�� Y � ) �,, � s. �y ,� � s� ,� a � � ��'�� � � /� �-�� �`C n o �� �� e\ .�, = k I � ` � � '� )� � V `I \ J � `` la �\d I� 3 � a ' � �� a� � � r at i• � � 0 1 R // 2 6 O ro V e) � `\\ � `�' V" c+- c�a. V�- V Y �1 Y o � f � N \ `�i� fj � Q � � �O Q h � .r J � • - • w � j ' s £ o Q `=- �- o T M r T � � � � O � Z � h n �, � � � � °' U- °� � � K n � o ) — 7 � T 3 ` 2 � � A o r � W n r� � N -- : o a o g' L w m r� c'� +U a W �, a _ a C'J . ra9� v_o�- �. Soil Profile Sheet ' �wntr._I"kt{�oe1� U��h.l Q� ��_, $Oil TPSl�2f:_ 1�ee�\a A SneecK�T� J��L� Sysxm Elevat;on: lad Rat� a� �.� Systsm Ran�e: 89.Sgto 9� 9� � 8a 83 . ...... ..... ...... ... ...... ...... ...... .... ..... .... ...... ... ...... 95 ..... ...... ... ..... .... ..._.. _.... ...... 9 4 .S$ ..... ...... .... .... . ... ...... 9 . 1'7 .... 9y ...... : ::: .... 9 3. SO ��: ::� . ... 93 _ .. ... ... F� �� : ::: F � L : ::: } Fi�� ... ... 9 a ::: �:: � - ... .. .. � :.. ...... 9 �. � ...... ...... � _... ..... 9 i.S� q ..... ..... , _. .. ...... � , ...... ...... �- � ---... � .. ...... � � � � '�'t' __... ...... 50. ...... ...... �°► ... ...... 90.�'O .... ...... �td sys Elev. Rangc . . .. ...... Sg :::: ::: 'S �� .. ... ::. ..: 89.S 8 �e��� .... ..... ..... ..._.. ... ..... p T ..... ...... ...... ...... 88 ...... ..... ...... ...... • ..... ...... ' .... ...... ►nis �TuSo� t ..... ...... .... ...... ... ...... 8� ...... .........- ..... ...... 8G . : ::: 8�•0� ::: ::: ::: ::: $�� Sg .... ..... .... .... . ... ...... - 8s, ya � ........ ..... ... .. ...... ._.... .__....... �---- ��---� _......... ..... ...... SY ... ...... ..... ...... ..... ...... ..... ...... ..... ...... ........... ��---� -�--- . .... ...... ...... ...... 3 ...... ...... ...... ..... ...... ..... ...... ..... ...... . ...... ..... _..... a .. ..... , .�/� ... ...... �s T a a� 1� /oq/oG ; � mr� vo-�+r+za � �o. .... i�xa eo-ur.zo '+0��� �.;.n zo.t m-u�-no m.¢ ro-i.� -rto e,.rp io:i ro-n�-rto —�S �N—MS MN 3S MN—MS �0. °ta r�'�'t .,c: '�i y�� �-urs.n 'o • 1� "�.i'►°� �g, �po��+^ ���''•� '4 mct c0-uc-rZo •<. , - •.�.c �ro . �oci ro-ut-rzo iDZi CD-�r� rb ror' �. T ���". e� O��` ..c i p� ti �.. C� SOIZ CO���L-fLD °•;'ui'-�y6� � .,. ��O o , a "'i�+r r'':'h. ..:.;. �o�4�r�: ra�2 co-�rt-rio �w+ r MN 3N � • o COL2 CD-u[-�EO i� , _R.,.: o�b:��J� .. -nl-rlll iDti 1'0-ul-Ko �-0���' �,;�.��,,, MN—MN —�h 3N—MN 'a;a'�° �4 t��t 2,� i_� �o i01Z PO-u[-r2o -^:�' � / �ti c � Samr� 901L i YDuI��Irlill �1 CO-u[ KO ����`' '� ���� Cp12 Y]��M�l�Ole [D-tsl-sL0 �•�.ipZL - .e.. LOi2 f0-U[-rtC CD-U['�LD _._ _ __.. . .__ �, I � I '"`""'-�"`^��;- PRIVATE ONSITE WASTE TREATMENT county ,�� ,�, �����o$ ,�', SYSTEMS ������ Ps =" ( POWTS) SaWyer �'`�f=���,;;r�ii - INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� ,�� l.� � Personal infonnation you provide may bc used for secondary purposes[Privacy Law,s. 15_04(1)(m)] Permit Holder's Name: ❑City ❑ Village [,�Town of: State Plan Transaction ID#: v���,ae 1 .�c�►-y1 ,����. �R.��,r,d� c.Gl� �— Insp BM Elev: BM Description: Parcel Tax No: ��1�•'�� a� Cd�C . S���O Q�'reo..v. �02`( --7�(�_ b3—�(0 TANK INFO MATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic • � �� Benchmark OO.o � Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet q6.3? � TANK TO P/L WELL BLDG vE"rTo ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. 1"3.�S� Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface `���yS� Manufacturer Demand Final Grade Modei Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMAT ON DIMENSIONS W 3� � 60' ,(,n' �� #of Cells 3 Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate INFORMATION P I L Bitlg Well Waters o GP ❑' Chamber Model Number: � EZFIow CELL TO .�(oa� -{-�p` .�— �- ❑ Mound o 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 ❑ Vo COMMENTS: (Include code discrepancies, persons present, etc.) � �,.�1�,� �'�-1 a z � �-P1q�.�- �I Is o,,( Plan revision required?❑ Yes 0 No i 3 I� ', . J ��!�(� � 1 Use other side for additional information Date POW Inspector's Signature Certification Number SBD-6710(R.3/01) A��ITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBEA: �o�—I �__. I ,_. _; .__�__ ._ _., _.:__. .. _; . _ ___., _ .. _ _ . : _ _ _:-.� -��---: , _ -- _ ; - - ___ � __, I . . . , , ' ; , t_ _ ._.._-- + -,__�- -_-� _ -- - `� : � �eX�J• � ' � ' . , . ,..._ __ .. . o la ; ' t �— ---- - i` ' , r�Q,�' �' ��K�° � � 1o�gl� �� Ta S�'' �`"Y 7? 4 �— s�a�r i -