HomeMy WebLinkAbout002-940-36-5612-SAN-2022-260 `'.l Industry Secvica Division Camiy �
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Sani Permit Application �°"T�"'°°� �
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i+aquieed prior lo obtaming a sanituy p��mit Nae Applirntion fams for�tateowoed POW13 em submitted W Pmjat Add�ess(fdifCecmt t6�mailing addresa) ef
the Depertment of Safdy and Rofeaaiwal Servica.Persaml infor�tim yw Movide may bt uted 6or aeemday
om m exade�e with the Pri Law a 15.D4 1 m,Smts. � Q
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tll.Type af Perm1[:(C6ak oNy one box on Hne A.Compiete Iine B if applicable)
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❑Holding Tank ❑Oq�er Diepe�snl Companmt(ezplain) ❑Astreupnent Devica(ecpL�in)
V.DI eraalffreotmert Area Informetlon:
Daigo Flow(gpd) Daign Soil A?qIicatim RaMBpd� �uPase�Area Required lc� D' I Ama
6A� lU � ��ac.o s�E��.�
660 6G� q ,
Vl.Taok Info Capuity in Tuml Y of Mmufactr¢er
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VII.Re�ponfWllNy Statement-4 the uoAerdtned.ouume rs'powPollity for lnsmllarbn o[the POMS dcoan on the attacied ptaas
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PlumMr'a Add�w(Sveu,Ciry,Sntq Zip Code)
� I.��y�4� C k�/ ti/ �� ►,�; 5�/89
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IX.Conditions of Approval/Re�met tor iNsapproval
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NO R�FUNDS AFTER
SBD-6398(R OBn4) ISSUE OF PEFMIT
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" Wisconsin Depariment of Safety and Professional Services ��� '�': P6one: 608-266-2112
Division of Industry Services �� � , �`;? Web: htto://dsps.wi.gov
4822 Madison Yards Way ^� � � '� EmaiL d�s s�wisconsin.g_o�.
PO Box 7302 ' � p �`'�
'.�iadison, wi 53707 �� ` a ;:� Tony Evers, Governor
� � /��
'k�,, �— ��� Dan Hereth, Secretary
�csio�:.�--
August 24, 2022
Condltionally
CONDITIONAL APPROVAL APPROVED
DEPT.OF SAFETV AND PROFESSIONAL
SERVICES
DIVISION OF I TRY SERVICES
PLAN APPROVAL EXPIRES: 2024-08-24
Plan Review: PWTS-082202009-C
SEECORRESPOND CE
ROSS JEREMY TOLLANDER
6881 Austin Lake Rd
Webster WI 54893
SITE:
Hart Mound Plan
14617W Highland Rd
Town of BASS LAKE
Sawyer County
Total Amount: $250.00
For:
Description: Four Bedroom Mound System \ Flat Site
Mound Component Manual - Version 2.1 (May 2022-2027), Pressure Distribution Component Manual — Ver. 2.1 (May
2022-2027), 600 GPD, 23 inches to limiting factor, Maintenance required, Effluent filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and
Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and
located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The
owner, as defined in chapter 101 .01 (10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with the requirements
of Sec. 145.19, Wis. Stats.
• Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper
soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the
site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed
until it dries.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining
that periodic cleaning of the filter is required.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shal� also receive a copy
of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated
and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,
the property owner must follow the contingency plan as described in the approved plans.
. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance
tracking purposes. RepoRs shall be submitted at intervals appropriate for the component(s)utilized in the POWTS.
A copv of the approved plans,specifcations and this letter shall be on-site durinq construction and ooen to inspection bv
authorized re�resentatives of the Deoartment,which mav include local insoectors.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall
relieve the designer of the responsibility for designing a safe building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on
this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation,operation or maintenance of the POWTS.
Sincerely,
l�Ri1'LG rP��yGG
v
POWTS Plan Reviewer—Wastewater Specialist
Department of Safety&Professional Services�Division of Industry Services
email: Katie.Petzel(a)wisconsin.qov
Cell: 608-574-1189
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESiGN
Res�dentiai kppl�cat�on
iNDEX AND TiTLE PAGE
Project Name;
Owner's Nams: Raymond Nart
Owner's Address: 14617w Highland Rd.
Hayward Wi 54843
Legal Description: Sec 36 Twn40n R9w
Township: Bass Lake
County: Sawyer
Subdivision Name:
Lot Number: 1 81ock Number:
Parcei I.D. Number: 57-002-2-40-09-36-5 05-006-000120
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
APPR�OVED Page 6 Management and cantingency pian
DEPT.OF SAFETY AND PROFESSIONAI Page 7 Pump curve and specifications
SERVICES ��C � �6� A�p�
DNISION OF 1 STRY SERVICES `�
�yC.q _ o�1�it
�/O /']'!��.t�,�
SEE CORRESPOND CE ��`'�I Y�� !, l� �.7 ,�yr
Designer: ROSS TOLLANDER License Number: 851954
Date: 08/12/22 Phone Number� 715-566-0202
,�
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. Qi/01, R. 10/12), and both
SSWMP Publication 9.8 Dasign of Pressure Distrlbutlon Networks for ST-SAS (01/81) and
PreSsure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12)
Version 7 0 (R 11112) Page 1 of 7
�
Mound and Pressure Distribution Component Design
Des�gn VVorksheet
Site Intormatton
�R or C i M__�� R� Residential or Commerciai Design Note� Sand fili(D)ca�ulations assume a
4Q0.00� Estimated Wastewater Flow(gpd) TaDle 383-44-3 in-aftu soil treatment for
1.50 Peaking Factor(e.g. 1.5= 150°h) fecal coliform of<=3g in�hes.
600.00 Design Flow(gpd)
0,00� Site Slope{%)
96.507 Contour Line Elevation (ft)
23.00� Depth to Limiting Factor(in)
�______O.60I In-situ Soii Application Rate(gpolft2)
Distribution Cell Information
� 65.00 Dispersal Cetl Length Alang Cantour(R) = 9.24 Cell Width (ft)
1A0 Dispersai Cell Design Loading Rate(gpci/fta)
-- _. _.
1� Influent Wastewater Quality(1 or 2} Are the laterals the highest point
in the distribution L_�._Y___�]
Pressure Disrtbutfan Infonr�ation network? Enter Y ar N
;C or E� e Center or End Manifold
3.08 Lateral Spacing {ft} If N above, enter the elevation ft
3� Number of Laterals of the highest point
0.156; Orifice Diameter(in) �����
__;
3.00 Fshmated Orifice Spacing (ft)= 9.10 ft�lori�ice
2.00� Forcemain Diameter(in)
__._______---,
30.00 Forcemain Length(ft) Does the forcemain drain back? �Y �
a 84.00; Pump Tank Elevation(ftj Ent�r Y 4r N
4.55 5ystem Head(ft}x 1.3 4.89 Forcemain Drainback(gal)
13.58 VertiCal Lift(ft) 87.28 5x Void Volume(gal}
0.80 Friction Loss(ft) 92.18 Minimum Dose Volume(gal}
0.00' In-line Filter Loss(ft) 35.54 System Demand (gpmj
18.93 Total Dynamic Head(ft}
Lateral Dfametar Soloctian ManHold Dlsmetcr Selectior,
in. dia. o tians choice in. dia. o tions choice
0.75 � '1.25
i.00 � 1.50 x ---X --
1.25 � 2.00 x
1.50 x x 3.00
2.00 x
3.00 x ;
Gallons/Inch Galculator�optional}
Treatment Tank InfoRnation ��20Q0.00 Total Tank Capacity(gal)
1250 Q0�Se_ptic Tank Capacity(gal) 53.00 Total Working Liqwd Depth (in}
Wieser_� �.__' �Martufacturer � 37.74 gal/in (enter result in cell 649)
Dose Tank Information Effluent Filte�Infonnatlon
�750.00 Dose Tank Capacity(ga{) j Pofy�Lock Filter Manufacturer
j-- _16.12; Dose Tank Volume(gaUin) (__ 525 �Filter Model Number
- -
�Wieser __ 1Manufacturer
Project: Page 2 of 7
�
Mound Pian and Cross Section Views
. . .
T
. •. i�� .•. .•.� . . . . . �
Observetion Pipe • Q�. .•. l
K ' ' : � r; — T
.'C,� Lt, A
W , 'i . • ' 1.
:• - - -- — g —��
�� i
� . . . . . . . . . . . . . . . . . . . . �
L
Maund Component Dimenslons
A 9.24 ft E 1$.00 in H 1.00 ft K $.63 ft
B fi5.00 ft F 9,50 in _ 7.13 R L 82.25 ft
D 13.OQ in G 0,50 ft J 7.13 ft W 23.49 Tt
60Q.6Q (ftZ) Dispersal CeEI Area 1525.85 (ft2) Basal Area Availabie
9,23 (gpolft) Linear Laading Rate 6.54 (ft) 1/10 B Obs, Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 99.38 (ft) ---�
..iliroi..... � '"'
..,,.,,,, ..,,,,..,, G
............... .........,...,
� F .: ;,� ...................... 98.08
97�g t�)� ^ Dlepersal Ce�l (ft)Lateral
� Invert
Dispersaf Gell �j: � :
Elevation D �
�;� �.
. ,� � z . . ,� , , i. , , ,
�� 1 `, S
' � 4 � , � � � � , �q' ,
�. � ,� r .', , ;� °a ,.::_ ,_�. . ; . , , . , .,_
96.50 (ft)Contour Elevation
0.0 % Site Slope
GsotexiiMe Fabric Cover
Sheding Key � �� Disp�rsal Cell See latera�deta�ls on
Q _ Topsoil Cap ��� 1.5 ft Page 4 for number,s�e,
2� """' SiJb8oll Cap � a _j._� � ' ' � and specing of laterals.
� � ASTM C33 Sand � T ,�. �,,;: F Laterala ere equally
� 7illed Layer � 0. ft TYp�cal Lateral ; spaced from the
� dlstributlOn c�ll's
� � Aggregate �► �: � centerline In the
�----pti --� di�tribution celf(AxB).
Project: Page 3 of 7
End Connection Laterat Layout Diagram
c�rn�r�►.�iNerstsowr�n�,aasa.r.�r.yw.� •. lurn_Lpwrp���va�worc���noutp�uy
p ____.-- �
A�t+b�ltJ13 a/f W►ntMa1 �w-X—r I F4otra d�iikd on�fw bo�rtrrn W�M I�t�rM
.yu,ry:P,�.a S
L
r - ----- _ _. __-- --�
leRerds 8ldcrmeir� ScM+tf1 DVC pn SPS TeWe 38d 30f,
y
�..'NC.f IniM iOM�0��41\V���N 01 C/OIf�O T�R110IE i� �MJ�NM
Number of Laterals 3 Orifice Diameter Q.156 in
Lateral Diameter 1.50 in Onfice Spacing (X} 3.02 ft
Lateral Length (P) 63.42 ft Orifices per Lateral 22
Lateral Spacing (S) 3.08 ft Orifice Density 9,10 ft2/orifice
Lateral Flow Rate 11.85 gpm Manifold Length 6.16 ft
System Flow Rate 35.54 gpm Manifold Diameter 1.50 in
Total Dynamic Head 18.53 ft Forcemain Velocity 3.63 ft/sec
Dose Tank Information Locking cover wrth waming
� �ebel and Socking device and
aealed watertight
Electricai aa per MEC 300 antl -'�
SPS 316.300 WAC �41n.mfn.
oia�acc
---,__..
Tank component is propery vented .`- E— Altsmate autlet
IocaGon
Forcemain diameter
Wieser Manufacturer 2 ��.
Ca aci 750_00 Gallons —fi
Volume 16.12 galfinch A
Weep hole ar anti-
Dimension Inches Gallons g , siphon device
A 32.81 528.86 �
B 2.00 32.34 � Pump oH ekvation(ft)
C 5.72 92.18 � 84.50
� 6.00 96.72 p
Total 46.53 750.D0
� Dose tank elevation(ft)
3" Bedding un er tank. � 84.00
Alarm Manuafacturer levelalarm Note Sw�tches
Alarm Model Numbe� dvl containing mercury
m�y n�t be used in
Pump ManufaCturer Z011ef this system
Pump Model Number Bn 152
Pump Must Deliver 35.54 gpm at 18.93 ft TDH
Project: Paga 4 of 7
Mound Srstem Mainbenance and Qt�eration Suecifications
Service Provider's Name Ross Tollander ` � Phone 17 6-566-0202
POWTS Regulators Name �— Sawer Count� �I Phone 715-634-8288
Svstem Flow and Load Parametera
Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow-Average 400 gpd Maximum BODS 220 mg��
Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 600.6 ft� Maximum FOG 30 mg/L
Type of Wastewater pomestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Fret�uenCY
Septic and Pump Tank Ins ect and/or service once eve 3 ears
Effluent Filter Should ins ect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Shouid test monthl
Pressure System Laterals should be flushed and ressure tested eve 1.5 ea�s
Mound _ Ins�t for pondin�c and seepa�e once every 3years
r)ther��_ � _�
Miscellaneous Construction and Materials Standard�
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 mound component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code.
3. All gravity and pressure plpir�y rna�erials coniorm ro the requ�rements In SPS 394, WIs.Adm. C:Ode.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished •..�,�........ ......
Grade ���������
�
6-8" Diameter Lawn --.� . Threaded Cleanout
5prinkler Valve Box Plug or Ball Valve
Distnbution
� Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Pro�eG�� Page 5 of 7
Mound Systam Management Plan
Purouont to SPS 383.64,Wis.Adm.Coda
oen.re�
This system shall be operated In eccoMenoe with SPS 382-84 Wia.AEm.Code,and ahsll msintained in accorclance with ita'camponent
manuals[SBD•10897-P(N.Oi/Ot,R 10117j,SSWMP Publiration 9B(�1l81),and Preseure Di¢tnbuNon Componont AAanu71 Vpr.2.0 SBD-
1 W06-P(N.01/01,R.10112)]and local or state rules peRsininy to system meintenanceann mainEenence reporting.
Na one ahould ever enter a sepGc or pump tank since Cangeroua gesos may be prasant that could ceuae death,
Septic antl pump tank abenConment shall be in eccordance with SPS 383.33,Wie.Adm.Code when the tenks are no longer usetl 88
POWiS components.
Saptic or pump tank men�ok risere,aceess risen and covers ahould be inapeetetl for water tpMness end sounGnesa.Aeeeae openlnpe
used for senice and assassment shall he xaled watertlght upon the compleiion of service.Any opening tlECrt1Ed 11�50�110,tlC1ECtivE,0�
eu6jcd to failure muat be replaced. Expoead acceaa openinga qroater than E-Inchea In tllameter nhaii Ge aecu�0tl py an ettecllva locking
devics to prevenl aeoidental or uneuthorized entry Into a tenk or componeM.
Saotl[Tank
The septic lank shell be maintained by an individual tedi/red to service eeptic tenks under s.281.4B.Stats. The contants of Ihe septic
tenk shall be disposed of in accordanca wlth NR 113,Wis.Adm.Cotle. The operatinp crontlitlon of the septic mnk and outtet fltter ahall be
asaesaed at leaet once every 3 ycara by inapection,
The outlat fittar sllall Ce cleanetl as neces9ary to ensure propBr opBratlon, The fllter C2rtridge shoultl nOt Ge f8mOv8tl un186S provlsi0n8
are mada to retaln aolida In the tenk that may slough ott Ne filter wnen removatl from its enGoaure, If the fil[er Is aqulppeC with an alertn,the
flfter s�au be servicetl If the alartn is ecnvetetl continuouay. Intermittent filter alarms may intlicata surge fiowa or an impentlin9 conGnuaus
alarm,
The aeptic fenk ehell keve ita wnkentn romoved when the volume of�ludge end acum In Che[ank aMceetls v3 tbe flquW volume of the
tank, If th8 COnIp�tS Ot th8 t2nk 9fe not f9moved et the time of e triennial asseacment,maintenance perconnel shelf advfse the owner of
when the nezt sBrvice neads to b!plrfOfrtlBd[o maint7in IYss th9n mOximum scum ene etutlge 9CCumulalion in ths tank.
The etldition ot blolopical or chemiral edditives to enhance septic tenk perfortnance is generally not required. Hawevsr,if suCh pmduds
are used thny shau ba approved ror sepnc tanK use by ttte DepaRment of Commerce.
Pumo Tank
The pump(dosing)tank shell be inepedetl at leaat onte every 3 yearg.All swttchas,alarme,and pUmpa shall bb teet9d!0 v8rify proper
� opeialien. If an afflusnt fiker is inslalled wdhin the fank A ehall be inspeeled and sarviced aa neceneery.
I
, Mound and Prsasure Dl�trl6u41on SvsNm
��, No treas or shruEs sh0uld ha plantetl on tne mound. Plamings may ba made around the mound's perimeter,and the meund shell be
seBdCd end mWched a5 neca8S2ry t0 D�BYBOt eI08i0n 8nd t0 provide some prOtedlOn from hoat penetration.Tnffic(Mhor thCn Tor
vagetative maintanance)on the mound is not recammanded aince aoil compadion may hinder aeration of tha infiRrstiva aurtace wRhln tha
mounC antl snow wmpectlon In the wiMer will promote frost penetratlon. Coltl weether ineta118t10f15(OCto6ehFBbNBry)tliCtBtE th8t thB
mound be heaviry mukhed es pratedion irom freezing.
,, Influent queldy Inlo iM mound syalam may not axceed 220 mg/L BODy,150 mglL TSS,and 30 mg�L POG fOf 88ptk t811k 6ftIUB0f Of 30
��.. mg/L B00a,30 mp1L TSS,10 mp1L FO�,and 10'cful100 mL for hiDhiy treatad effluent.�nnuent flow may not exeeed mexlmum deaign flow
I specifled in the permit tor thia installation.
Th2 pfessure tlistribution system i9 providetl with a flushing point at the end of eeeh ISMrsI,and it is recommeMed thet each laroroi be
Nushed of accumulated solids at least onee every 18 montha.When a preseure esst is performetl n ahould be aomparad to tha�nRial taat
when the system was instelled to determine ii orifice dogging has ocaned and if orifia cleeninp Is required to mplataln equal dlattlCutlen
wittiin the Oinpersel cell.
Oba9rvetlon plpas wlthln the dispeRal Ce11 shall be chedte0 for effluent ponding. Pontling 19vels Sh9ll be f8p01Sed t0 Ihe OWfler,end 7ny
Ievsia e6ove 8 inchea conaiGered as an Impending hytlreulic failure roqulring addRional,more frequent monitoring.
co�unaancv Plan
If the septictank of any of i[s componen[s bacome defeetive the tank or component shafi be ropeired or roplaced to keep the system In
proper oparaSing contlition.
Hthe doaing ta�k,pump,Pump controls,elerm or related wlring hecomes defective ihe defective compoixM(a)ahall ba immedletay
repoirod or roplacad wilh a oomponant oi lhe aeme or equai pertvfmanGB,
Ifshe mound component feils to accept wastawater or begins to tllsc�alge waStewetef l0 tha yround surfaa,R will be npairetl or
replaced in de'present iowtion by inueasing beaai area if toe leakage ocwn or by removing biolpgically GWppetl a080�ptlon and dlgpetSal
media,and�elated pipinp,and replaclnp aaid componente as deemetl neceaeary tp bring the system into proper OpBtiting Cofltllli00,
Sae Pape 5 of this pl9n tor the name end 2elephone number oT your local POWTS mpulator end aervica provitlai.
Prntrootmanl Unfb
The IiHortnetion antl scheduls ai mananapement and maintenance for pretreatment devite9 suah es aerobic treatment unlla or dhirifection
unib are a@achetl as Sepafe�e tloCurtlents antl aro ConsidEfBd p8R Of th8 OVCfall R1BI12pBm8nt pl2n fOf thi6 system
Projeet: Page 6 of 7
TOTAL DYNAMIC HEAD �`�
FLOW PER MINUTE � � ��p PERFORAdANCE CURVE
M�EL 151l152l153
�
MODEL 151 152 153 14
�s
�c �� a�. s.� o�r. ur� c.i. u�.
s �,6 ao �eo eo �+ n ae4 ,� �o
10 ],0 46 170 et 231 70 2�f
16 4.8 98 111 53 401 !1 431 � � ��
20 e.i 2p 110 14 1B7 32 181 10
46 1.9 18 E1 34 t�p 44 i5D - �
JO 8,1 — — Z9 B7 39 123 8 � 161
85 10.7 — — — — 22 88
4D 11.2 — — — — 11 42 � 8 �
Shut�ifH�d; 30rt. .tm 36h 11,Em MA, }3,9m
fb
4
t0
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5 �
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0
10 20 90 10 SQ Qd p A4 AQ tOd
GALLFNdfi
40 80 4 t 4 g'p �p
ROVV PER A9NU7E a uaae
Modal .: � ', _ ,.<..., � ,, - , � ,
. . . . , , . .. , ,
: .. . :. .
&�! Mcrds Yqtte Ph Am�s ;i�IP H: Lt� Kg SlmpNx Dupl�c
N161 6tnple Non 77b 1 8.0 118 dG 32 7S 7 2 or 3
E781 Single Non 2S0 1 3.2 1/3 EO 82 15 1 Z 0►9
BN��� etngle Aura 116 i &0 1M3 $0 33 7b " 2or3
9E151 $llSgle /Ii1t0 230 1 3.2 1/3 $0 $S 1S • 4 or 3
N15T $ingl� Non 116 1 8.b d110 a0 37 17 1 2 or 3
f152 Sfngie Non 230 1 4.3 4/19 00 37 17 1 20�3
BNifi2 6inple Auto S1b 1 B.6 4110 80 $8 16 " 2or3
BE162 Sinqle Non 23U 1 4.3 4H0 BO 3s �a i sa.3
N169 Sinalo Non 116 1 10.b t!2 ap 3> »
BNi83 Singie Auto S15 1 1�.8 1J2 60 39 18 • 2or3
et63 5�npie Non 230 1 6.3 1R 80 37 17 S �or3
BE769 $fngle Non 230 7 6.3 1/2 60 3g !8 • 2 or 8
•eN ,�d s£ rnodsls Ineludr a 20' 18 m)pipyypaQic varisbiq tevel pump awiLch. Rddltianel Wrtl ISII�hi�if'0�Var�abie in 28� !8 mt and 35' (fl ml. 50' 116 ml card.ara
evai�,ble�e.x�v�nita only.
NOTE: Mode1161 hu a pla�tic bne.Mpdels 132 de'16g h�ye�ca�t fron ba�e. �
SIsZ6CT10N GUIDE
�. For automatic use aingle pigsyback variable ievel fluet switCh or double piggybadt verieble level float awitch.
Refar to FM0477,
2. Ses FM1228 for correct rr�odel of simplex corttrol panel.
3. See FM0712 for correct model of duplex control panel.
CAUTION an in.alf�don o� w�trota, protralon dwlcas and wirinp �hoWd b! don� Iry a qusl�ad liaen�sd elsarici�n. All �leetrtcel and ufety codei thauld tr�
follaw�d tneEudlnp th� me�t ne�nt N�tienef Elsetrlcal Ccd�{NEC)ene the Occupetional Saf�ty�nti Heekh Aet(p8H11�.
�Copyrfpht 2074 ZoAlle�Co. All rights r�servsd.
502-778-T731 � 840-828-7867 � 36d9 Cane Run Rasd j Louiaville, KY 1021'l-1981 J www,:oeller.com n �
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��"�""=='`? INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� _2�o
Pe�onal infonnation you provide may be used for secondary purposes[Privacy Law,s. (5.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�a o� a c l�tS �� Pv��roB a- O Oo r L
Insp BM Elev: BM Description: Parcel Tax No:
loo .a ' �ra: i� (o`' I�J�Q ��-- ooa ��Ya� 36 —s�I
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �� �„ �,,,ie�� - '�� ��� Benchmark (OO,o'
Dosing .,�-a�, � �Sb 5T' �y'1- `Z' •��
Aeration Bidg. Sewer —
Holding St/Ht Inlet c/y, � '
TANK SETBACK INFORMATION St/Ht Outlet �r Y,2'
TANK TO P/L WELL BLDG vENTro ROAD Dt Inlet
AIR INTAKE
Septic �-a�� �-5b� }- p ��,� NA DtBottom qd�/b r
Dosing y Q. u y Nq Installation
Contour ��•S7
Aeration NA Header/Man.
Holding Dist. Pipe 9'��1$`
PUMP/SIPHON INFORMATION Infiltrative t
Surface �?•s$
Manufacturer �� Demand Finai Grade
Model Number I�'-,Z GPM
TDH � Lift Friction Loss Sys Head TDH Ft
Forcemain L �3p Dia �" Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W �j„�, L (o S #of Celis Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv � Aggregate
INFORMATION P�L Bidg Well Waters � �GP ❑ Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO �� ��� �},��y� �✓ Mound o Other
-- -- - - ---- - ---_ __
-- - - - ---
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Mar�ifold ` y Distribution Pipe(s� << I X Hole Sizeu X Hole 3,Q� Observation Pipes
Length �Ib Dia l.S Length��.Y� Dia <<S _ Spac �a� � o� E� Spacing Yes ❑ N�
SOIL COVER
_ _ _ — --
___.
Depth Over � Depth Over f Depth of � Seeded/Sodded Mulched
Cell Center ` Cell Ed es �� � To soil � L$Yes ❑ No
�_�' 9 ��- I_- � �_---� ��Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
�--��,� ll� ���-g 1 a�
Plan revision required?0 Yes❑ No �3 0� �3 .. I- � ��i / �
w=��� i'e
Use other side for adtlitional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADOITIONAL COMMENTS ANO SKETCH
SANITAAY PERMIT NUMBER:_��=��
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