Loading...
HomeMy WebLinkAbout008-273-00-0700-SAN-2023-161 N L �r�""'�"k�� Department of Safety �°'���ryer tn f��-� &Professional Services, � ?F� ,�� Sanitary Pertnit Number(to be filled in by Co. ' y �r lndustry Services Division ������ 639 226 �, Sa111taI�/ Pf'I�1111t f�ppIlC�1t1021 �iAtl(SIGY✓� Sta[e Tran�action�umber � in accoreiance wi[h SPS 383.21(2),Wis.Adm.Cude,submission of this form to the appr�na[e govemmen[al unit � is required pnor to obtaining a sanitary pennit.No[e�Application fonns for state-owned POWTS are sabmi[ted to Projec[Address(if ditferent[han mailfng addr � thc Dcp;irnncnt of'Safcry and Profcssional Scrviccs.Pcrsonal infomiatiun you pro�'idc may'bc uscJ fi�r sccondary puiposes in accor�lance with the Privacy Law,s.I$,p4(I)(m),Sta�s. '� — l.Agpiieatio�In[armattan—Please Priut AII Information Property Owncr's Namc Parccl# John& Karen Schroeder - - -.17 -C�O -O OO Property Owner's Mailing Address Property Location 29257 230 th ave �o�� �o� City,S[a[e Zip Cndc Phonc Numbcr Holcombe Wi i 54745 715-577-8460 '�, ':, s���;�� 2� �.'��(�C Uf����{��[811,,t�lAt SPP�Y) Lot �y 7 38� R 9 E or W 2 Ufllt / SubdivisionName ,�1 or 2 Family Dwclling Numbcr ofBcdrooms ____ Z Aio� Ridge view ❑Public/Commercial—Describe Use ❑City of — O S[ate Owned—Describe Use --- CSM Number ❑Villagc of _ r�T�,��,�,r edgewater IIL Type of Pt'�WTS Permit:(Check either�New"or'�Replacement"and uther 8pplicable oa line A. Check one box on line B,Comptefe line C i a licable.) -- � , _ r�C � , Ncw Sys�cni i L 7 Rcplacemcnl Sys�cni . . Olhcr Mudiilcuhun lo[f�isung Syslcm(c�plain) �_� Additiontil Prctrcalmcnt Unit Icxplain) B' �Mound ❑Individual Si[e Desi ❑Other T e p ❑Holding Tank � In-Ground ❑A[-Urade gn yp (ex luin (con al) ,� Li,at Previous Permit Numher and Datr Issued C. ❑Renewal Before Revision � � Change of Plumber .�Trunsfer tu New Owner Expira[ion i �2— �3� � � � IV`.IN� ri�1lTreat�Rrtt Arca an�Tssk InformaUoo: Design Flow(gpd) � Dcsign Soil Applicatfon Ratc(gpd/sf) Dispersal Arca Rcquircd(s�j Dispersal Arca Propuscd(sf) Systcm Elcvation 300 0.7 429 440 ����{'`�y�6 Capacfty in Total #of Manuf�c[urer � Tank Information Gallons Gallons Uni[s � V V'° _ � Ncw Tanks Existing Tanks y � w ` y � A �y a U `n v �n ii C7 0. Septic or Hulding Tank 2 $ aW DusingChambcr x [�0�, ( S�F'��iJ �( V.Respo�sEb3Uty S#ftte�Y-I,thc aadersig�d,assume res�wnsibiifilg f��sad�atloa nittre PC?WTS show�an i6e�ttacbed giaas. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone tiumher David C. Laird 221253 715-239-6194 Plumber's Address(StreeL City,Slate.7ip('ode) 20165 Co. Hwy. "Z" Cornell WI 54732 TTL,Cu nty artoe�t[Tse Only �Ap� v � ❑Disapproved �ermi�Fee� ' � atc Issued Issuing Agent Signature �� '�,`'o � �-,��3 �`l��.�;G�.(-��-4v��� ❑Owner Given Reason for Denial Conditions of Approyal/Rcasons for Disapproval � " "� CS'�' ��- (6�( �4.. ` � � � GI �� . � -� � � s � ��_� � Attach to complete plans for the xystem and submil to the County only on paper not Iess than A U2�11 inches in 'e SBD-6398(R.03/22� ��a:�te ? �-7 �' ,-, ' ', �--� , � , �����[n1 /� r,. � �, �;"_!j���•� I"; r , _ � �.�,_, �i NO RCFJt���AFTE� i:hk# �3�(�yM.,�.�.�.�.�..�.m _� � �1 -'�-_'-;;�� , �?� �i 1 : issu�o�r�R�i� �cpt# a3�� . �:'t �.IU�'� 15 20C3 , , —____._�.,:x ��.kr�j�'��� "y`1�.i;`Tef ZC3NIfVG ADMlNISTRATION �JC� � � ?�~ R�' Q7 ���) '� I � i � _.- . ._.___ _. . ---^-.. .. ..,..-,.-.. . . . . � i _ .»-...._. _.._._,. _.__�. _._._..._._.. � � � "___.__ ._"'_' _'_""' ' _'_. ( C ' ' 'I _' , q ��, �� ; � t i I .� o =� _ ._- _ , ��s ,,, _z i � 2 1, `'" ,C� 1 �Ya fi {` 7 U� � � h ��� l �' ���Q-�'�� '�' � `� � t� ", \ _.- � � � � � e __� - _� �_� �r-- � � � �. � r O ' `q c` �_ I �tt � ' ' � ,11 � Q � oC q ` � � � io `� Y u' � � 1 ' ce � �t.� � � � � , �, � � _ �1 � 1 � .._ + �i ' — Cla- � � � � �' � �1 c4= �. � � �. �� �� � � � � � � � U Q i , � � �n � u ` ` � ��,_ �; _ �, � � C`-� c� � ''� i 4� �! o o CV 1 � � � � � % � � �' n�-t C�� � �' ` � , i I � � � 1' �• Y ,, n Clt c ' ' � ''. \ ; t �.. ���Y g n I �; � n `_- ��,� �� � , I k Z�� � � � Cn o �A � � tr ., � � � � ��' � � � (Q � �_ � d\ � �� � � � y.� \ � � ` N� Q _ � � � � `'J � �� R � \ �, ,� \1 \ � ��._ �� � �� p , � \ , � _ i . _.__- �� � , ; '� \ � , ; ----__�_._ .�_ --------------- ic? �,a ` 1 \` 1` i ' i � x � �- 1 ; �1 � 1 � , � .� � �I� � , \ � � ` p i � � � , �,, = ; , .�.-1 1 , � , _ __ . _ � � , , ' - � — ----- -- - -_ ._ __- �y Cl �. _ „ � . � ctl � � � �'.� .� ,A. ��� � � � � �.� ' � .��._ 1 � j I � �\. � � �� _/ ' ���� � -� i �. � � � \ � �. � � '� � � .� I � �� �, i._ \� ` � � � � ('�tl � � � � � �J l41 � � �\ � � -'' � � � z `� j 5� �_ � o �' � `°� ^ � \ \ oy 5 N � Y - x- : � 1 (^s._ � i � n,� ,,M � z i �� � 'o �� � , =��a� - ,� 4- z � � "' �° � � �� �- `'- 1;,3 � � ``_,, � - r'� w +� � � � � i ; Qk � � � r �, � 2 i �� ���' "' '� l � �' � � 4 a t �� � � � -� I l� � 1 � ��f. �� ti Sx-�. ��.. � t ��� �n v� cn, � r,— hDv � o.. �sl , I � � - � � � � �_,����, �� °� � ! � ' ��,, � r� s � i � i � � Z � � ; ! � � � � I; � �`�� 1 � �� o m � Q o � �� �, � � � v � v -:,- �' j � U 4 °i �r� ;.'i �� � 'N � + � � I � 7;. � � (Y' i-,. � <r- n T � �.� ' V `Y - W � a' �3 °� �I ' �: +� u, � �n '�r_ � `� � `,3 ��l �� � � p � � �. f � W ` � �`l �� l� � � � 1 � I Q � � - . � �� C L� � i �� � U.1 M �� .� C`_ C� � � � � � � -�-' I Q� � c� 1 � Z � r � U (� J '�--- — , ; � � � � � �n �u `n �, `; � tn 'y � j r� o �a t� � � 9 2 I � �. ��` � v � �. �� 7 " ,r� �'� � _ tY ' ; .� � �; o c� �� � � f- m! 4' � �7 � � ; � � �7 � � � � < � i- �_) � � --t . I i n i � I ' i f6 � aF 8 , ` � :c "DOSE-MATE" 151, 152, 153 `�+�:', �� ,� '� ZBN151 �N151 1/3 FIP U5/1 Ai,ioma��r Cesl Iron tl2�'Solids 1��-2� I��;c lathered Flost(2U') ZN15f N15� 1/3 HP 11511 Manual Cast Iron 1/2'Sobds, 1-ti7 D�sc ZBN152 BN152 4/10 HP tt°i!t �lutom��Uc Cast Iron 3/4'Snifds 1 1i?��D�sc fethe:red Float(20'1 ZN152 N152 4/10 HP 11Gilt MB�tua1 Gast IrOn 3l4"SohdS t-t;?�f��sc ZBN153 BNt53 1l2 HP 115l1 quiontat�c Cast Iron 3/4"Sobds. 1-1�7"[)isc Tethered Float(20') ZN153 N153 il2 HP �1511 . Manual Cast Ir�n 3/4"5oiids. 1-ti2"Disc ZE153 E153 1l2 HP 23011 Manual Cast Iron 3/4"Solids, t-ti2"Disc _ . _ � i FEATURES: i �;m vu�rE�oawwcFcur� � I he"DoSe Mate �s construcled of i Mooet is+nsu+s� BN152 durable cast iror� carbon ceramic � .� , .,,j ! ' ' } i seafs and a n�n-cloc�ing vortex � ! 1 ' f � �mpeller i � ! � � , � � 20'Cord i � � � � i ! I i r I � ' � f 1 i , a���caT�oNs: � ; �; r � {_ , . � } � , ! ; ; 1"he"Dose Mate' is ideai for sept�c � �� � ; � , � �, ; I � �anks,dos�ny, low prassure pipes, i ., � j �, _ ._ _ ,__ , �` niounds and step systems �� ' � __; ' _ ` „ � $� � i i— t — � � '{ I I i , i I i i � � , ,�_.. i -. , m x r ro m a r, r �� ��*[o�p`, w s x .x� x�� �,. iK ir� w. . .. � 4i.e...cwr�rr .�.v.0 � � � ... . . _ . . . . . ..._. . .. . . .... __....._._ '.__' -. ' " �OdCflQOVq1l�1'I�1� ��-'-i�fl�MtQ b�MlpA�b�IM FAmtoruPKNFC30D-- ..------.__L�__._�wledrwr�M md Cdnrtt 5E 2d YMC - � � ' ---..—... __.- -_.—_ 1 in.mn. _.,,__.__.__�, �y�wR, ._.� --�_-.--___--- _= -._ _,.. ._ _ ___.. � � f I/� ouMlloa�ar TMt omqa�rN R W4�Y+�e�t r�_ _ �...._ ._..__ .._. ..._� I .. _. l_..._ . .___ ___._,_'J ����� I ___1 Hufhutt Manuhcturer r_--- G act 602 Gollons � Vdume 14.33 gai(iruh � �``�°�� �--- n►.epnm aw1a� --- Dimenston Inches Gallons --- I I A 25.56 3fi6.l3 C i B 2.00 -_ 2B.66 + _. � 4 vunp ar�.rrm�rtl — - ---- t__ __� I �----._. C I.45 3515 � � , i 91 D 12.00 171.96 � C^_� _,_. Totsl 42 Ol fiQ2 00 � __ --- � ( ._ --.- --- _ — � I __.__ _ 1 1_-- --- —� ooawrrv.rml� �_ �--.._.__.. MFn 3'Bwi�+p v,ew ar�. i I�.J _.... ._._.___... --- . �_._._.._� .—�.--------_--_--___-' Alarm Mmufacturer SJE Rhombus � � Alafm Model Number �.`-- NW I01 Pump Manufscturer IoeNr�r Pump Mafel Numtwr �~` 151 d� � �___.�.____.__._._____�_—�-__._�. Pump Must Delfvery C�"20.46�gpm at ib,14 h TOH Prafed: JoN sc N Q 0 r O�'R , Pepa 4 of t i r i'�''`=T"-`�'r,, pRIVATE ONSITE WASTE TREATMENT county � , ���;�Sp �����'�; SYSTEMS SaW er �':�� $ /� ( POWTS) Y �O T` _��=./ `''-"'-�"''� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 2 3, �� I Petsonal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(in)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: ,o��n d-1�-�-� ��� Y�se �d e��-�r� �- Insp BM Elev: BM Description: Parcei Tax No: �Gb,b' �`T��, �'� s�� C�g-�73 -C7a -c�?o 0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic -700 �,p Benchmark (pp,o � Dosing --��� (60 Aeration Bldg. Sewer .. Holding St/Ht Inlet q os-� TANK SETBACK INFORMATION St/Ht outiet 97.9' TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIRINTAKE Septic D' �.��' �, � .}{o � NA Dt Bottom `�Y.� � Dosing �� �� NA Installation p �, Contour Aeration NA Header/Man. c�9,�r Holding Dist. Pipe PUMP/SIPHON INFORMATION Infiltrative Surface Manufacturer (�-� Demand Final Grade Model Number GPM S S. ( 4��S� TDH Lift Friction Loss Sys Head TDH Ft �c , (�, �'' Forcemain L�i(�'� Dia � �� Dist.To Well fi"� DISPERSAL CELL INFOa ATION DIMENSIONS W � L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate ^ j P/L Bldg Well ❑ IGP Chamber �' INFORMATION Waters � AG �EZFIow Model Number: CELL TO �D .f-� � o Mound o Other - --- -- — - --—_ _-- _---- DISTRIBUTION SYSTEM X Pressure Systems only — ---- - Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes — Length __ Dia Length Dia Spac _l Spacing �Yes ❑ No � _. _— _— — ------ ---- SOIL COVER - ---� — - Depth Over Depth Over � Depth of Seeded/Sodded Mulched Cell Center Cell Edges ; Topsoil __ _ I ❑Yes ❑ No ❑Yes ❑ Nc� COMMENTS: (Include code discrepancies,persons present,etc.) � ���f(�( s(�-��23 ��� � ��al�b s��� --�� --- ______--� Plan revision required?�Yes ❑ No o� �� �Y � —/ � ��� // _ �� _ I to Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AODITIONAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA'�_�_— 16� �� ��. �`�' �`�'� ; ._ _. ---�-. ._. .;._ ____ _ - - • - -- - -- - � --. _ _ _. _ _ _ ;_ _.,_ ; __., .._ .; . : , ; . _ : ;_ , . . _ . � �l: . _ ; ,,�,e. ; : . . .: � . __' .__. i .'_ . .� __:. __ ;. _ . , : _ _ a , �'�' : ; ' _ _ : . .. : _,. ___ . ;._.__ : , brA" �� ��> L`� x 6� �Yo �1� ' / N �oy' ' .r� � � ��5� �� l� � fi�2� �" ('.�- , N � •.4t�l� _ — _1_ 3 � `n7' � 3� ���I�° --� � ���-fi: � � ` � � � n—T;--� � �,,, 'C - �b • �