HomeMy WebLinkAbout010-941-23-3119-SAN-2023-193 _���"`-"'�.�i Industry Services Division County V1
4822 Madison Yazds Way �L'CwY P/' �
-^ ,�_' = Madison,WI 53705 Sanitary Permit Number(to be filled in by �
= P.O.Box 7162
Madison,Wl 53707-7162 Lp S � �� � w �
.�J
Sanitary Permit Application State Transadion Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit W
is required prior to obtaining a sanitary permit Note:Application forms for state-owned POWTS are submitted to Project Address(if different ihan mailing a�
the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary S���
purposes in accordance with the Priv�y Law,s. 15.04(1)(m),Stats. �
I.Application Information-Please Print All Information
Property Owner's Name Pazcel#
�/�f� (.�i'e l�� D/D•�y�•.z 3•3i ��
Property Owner's Mailing Address Property Location
��7 3��� ��+C�( D•9 T/`1 Govt.Lot
City,State Zip Code Phone Number � )
1 ��/L '/., s�Y., Section � 3
l-�a. w:,� C,�J1- SYIs N �
II.Type of Building(check all that apply) 3 Lot# '� T � N R E
�1 or 2 Family Dwelling-Number ofBedrooms Subdivision Name
Block# �'
❑Public/Commercial-Describe Use —
Q City of
❑State Owned-Describe Use CSM Number ❑Village of
$I Yti� � l g�� �a,�of /�yw�.�—
III.Type of POWTS Permit:(C6eck eit6er"New"or"Replacemeat"and ot6er applicable on line A. Check one box on lioe B.Comptete line C i
� licable.
A" ❑New S stem
y �Replacement System ❑ Other Modification to Existing System(expiain) ❑Additional Pretreatment Unit(explain)
B' ❑ Holding Tank ,�In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner �st Previous Permit Number and Date Issued
Expiration �ST��7-3 3��s�-����-3 ys
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Applica[ion Rate(gpd/s� Dispersal Area Required(sfl Dispersal Area Proposed(s� System Elevation �
ys� � -� ��,�.y b s.o� �- ,� -�s-
Capacity in Total #of Manufacturer
� �
Tank Infomiation Gallons Gallons Units � � v � ^
New Tanks Existing Tanks � o � 2 � p i� c`�
a U �n H vz w C7 0.
Septic or Holding Tank �� /�0� r�[��' x
Dosing Chamber � f v r,I�P ��'nP j�/�E��j� � I.1/r rs<!— �
V.Responsibility Statement- I,t6e nHdersigned,assume respoosibility for installation of the POWTS s6own on t6c attached pl�ns.
Plumber's Name(Print) Plumber's SignaYure MP/MPRS Number Business Phone Number
,�9-e/'�i�G� �iz��� � ��'��� J�/// �l3= S�S��//3�
Plumber's Address(Street,City,State,7.ip Code)
l3S B.2 G,.� �'��.���/ /C'� l�a w���, !�✓� S`-y�y 3
VI.Coun /Department Use Oniy
y Permit Fee Date Issued Issuing Agent Signature
�,A r�v a ❑Disapproved L-^�,,-
I�O�vner Given Reason for Denial $ `O��J � �� �j�� -�� I�T�"�"'`�
Conditions of ApprovaUReasons for Disapproval �. �-.`�---���r?^`�
: �' � c���_3. _. _�.r..... � � �`V ' �, l ; ,
j � t,� i; � r
��' � ��� � �_�,, � � `,�_ -:��
� �:�k# i a l a ,. � -,
AUG 17 2023 �--�
� S�— �4;,, ; �c�� ( �
��-3�3� _ � � __ � - , ,,�� v
SAWYER �STRATION
ZONING ADM
Attach to complete plans for 16e syste�and snbmit to the Coaaty oely oa paper not less than S trz:11 inches in size � '
n+o r���v�s�r�R �5-�- o.,� ^ °t3 -��
SBD-6398(R.03/2l) ��U�����i
jaS1 �
Terese Welsch Property Owners Name
10733N Namekagon Trl Property Address
D10941233119 ,Tax Parcel Number
Sawyer County
NE/SW Gov Lot or Qtr-Qtr/Qtr
S23 Section
T41 N Town
R9W Range
Page Index
1 Property Information
2 Data Entry
3 Plot Pian
4 Drainfield Cross-Section
5 Dose Tank
6 Maintenanee Plan
7 Contingency Plan
County Parcel Listing
Gerald Froemel Plumber's Name
� Plumber's Signature
950111 Plumber's License Number
715-558-1138 Plumber's Phone Number
08/17/23 Date
Not an endorsement,written or implied for the folbwing companies and products;DelZotto Concrete,Wieser Concrete
Products Inc.,Skaw PreCast Co.,Huffcutt Concrete Inc.,Zabel Environmental Technology,ITT Industries(Goulds),The Pentair
Pump Group(Myers),Infiltrator Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,Simlfech Fifter Inc.,Sta-Rite
Industries,
Page 1 of 7
_a..��
In-Ground Soil Absorption SBD-10705-P(N.01/01)Version 2. Component Manuat Used
3 F�=Number of Bedrooms
°Percent Slope (%)
80 AT^Depth to Soit Limiting Factor(in.)
0.7 :In Situ soil application rate
300 Estimated Wastewater Flow (gpd)
450 Design Wastewater Flow(gpd)
1 Number of System Elevations
91.75 Proposed System Elevation#1
:Proposed System Elevation #2
"Proposed System Elevation#3
�Original Grade#1
� 94.25 Finished Grade#1
,Original Grade#2
Finished Grade#2
Original Grade#3
Finished Grade#3
Infiltrator Quick 4 Standard � Chamber Type
15 Hefght of Chamber (in.) 20 sq.ft. per chamber
2 =Rows of Chambers 5.1 sq.ft. per pair of end caps
3 Distance Between Cells (ft.)
32 ;Proposed Number of Chambers Used
642.9 Minimum Distribution Cell Area Required (sq.ft.)
650.2 Distribution Cell Area Proposed (sq.ft.)
���d;n7 ��IT�,�K���r�
Wieser 1000LP— ��,1,�� ,Septic Tank ose an app ica ie�, �
Lifetime � �Effluent Filter ""select only if NOT using combo tank
Soil Boring Surface Depth to Lowest Highest System
Number Grade Limiting Elevation Elevation Elevation
Elevation (ft.) Factor(in.) Acceptable
1 ; 3.00 -1.25 FALSE
2 f 3.00 -1.25 FALSE
3 3.00 -1.25 FALSE
4
5 .._..._
� � �
.,� - � 0
S
: h
e r� � �° x� o �� Z �.
� � � � � � � �, �_� � �
� .7 x �k. �� �
�- � � v � a � � �
ti E �'' � �v � � n
� � �. W � U
� �- � S lti -� �, �
� � � W 5a r
� 17 '� W w
� E �' w�"I �
� � S S.
�.' �r -S �
I �W * �f,
n �
M S
I _ _
� 4 e�`/�,� /�
�` _ — — �
_ __ _ — �
��
�' r�
i�
�I
0
2�
9 d
T
7. �
_�
�
Z
�� �
��
�
D W
` �I � Q °�3 �
T �I io r
� M �I^ .
�� ;� ,� � � ..�'
�
'_ �, �
(1 �r. 8 � s Z ,
^ s E_�
� 14 � , S �1
O �n
� Y
� �/�j �
aJ � �^ SF
� `^i � F-,L_��
� }� _ � �-- —
� �
�
�v,
�m �
��
Cress Section of a Two Cell In Ground Ccmponen ;
Using Leaching Chombers
05servotio^/Ve�t Pipes
� `
94.25 Finished Grade - - - -- Finished�race _ �
Slope /� Celi'Seperation /
_,_-.� � .� �? L--�Jf t .A
� „ '
,.� � ,-' �,�� 1
: ,� � � �" ?- -� ,
Original Grade_ _ �'� � >,�y, ,,''� � � ' ,Y-'"�, ,Qrginal Grade
93.00 Top of Chamber ___ ��� �� -' I __ „�_ 'y_:' Top of Chamber 93.00
- -�- - i � �' , , , � - ,
91.75 System Elevation .+• . . ,: � ��y System Elevation 91 .75
. • �.:����������_ - . ! - s . �_��� _:v._�'
_• .1'reotn±e�;�pnd' Dispersal .Zor�e �
, , � . , . . . ,
♦ ` , . ' . '
, . , _ .
. . , . , .
• . . � . . . .
-- � � �' . __ __ _ ' l imitinc Factor
' - - • -- '• • -
Observo, on/Ven; pipes to be constucted and copped with approved materiols for the particular use.
Dia rams Not To Scale
— - — - - —
, ,
� "�+�`f�����i-,�---�"��.�r�►.��'`�'�y��"."" ��
� � — 5 ..� � .�.� a�
� � ��e�mbs - .rsw�e`�'a�e�'��'�'�a��-� �
�
b
__ �
1
n
-- � ( �q
d
- —_.__ . _._ _
� i�:-��'"p�"'�,�►,�`��"�-�',�'"'���`� '�'�:
_ - _- :.��`��``.a��'��'a�:�'���``������,:•- �
�� i
bservation /Vent Pipes to be located 1/5 to 1l10 the length of the distrution cell measured from the end of the cells
Page 4 of 7
erese Weisch
10733N Nameka on Trl
1.09E+10
umber of Bedrooms 3 eptic Tank Wieser 1000LP
Estimated Flow(average)gallons/day 300 Effluent Filter Lifetime
Design Flow(peak).(Estimated x ts)gavday 450 Pump Tank #N/A
Soil Application Rate gaVday/ 0.7 Pump Type
Influent/Effluent Quality Monthly Average
Fats,Oil 8 Grease(FOG) 30 mg/L
icehemical xygen Deman ( s) 220 mg/L
otal Suspended Solids(TSS) 150 mg/L
,��;,_�����i Servicing frequency of 12 months or less requires the
Management Plan be recorded with the Register of Deeds.
Maintenance Schedule
ervice Event ervice Frequency
Inspect condition of tank(s) At least once every� 3 Year
Pump out contents of tank(s When combined slud e and scum=1/3 of tank volume
Inspect dispersal cell(s) At least once every 3 Year
Clean effluent filter At least once every 3 Year i
Inspect pump,pump controls&alarm At least once every �
Maintenance Instructions
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following
licenses or certifications:Master Plumber,Master Plumber Restricted Sewer,POWTS Maintainer,
Septage Servicing Operator. Tank inspection must include a visuai inspection of the tank(s)to identify
any missing or broken hardware,identiiy any cracks or leaks,measure the volume of combined sludge
and scum and to check for any backup or ponding of effluent on the ground surface. The dispersal cell(s)
shall be visually inspected to check the effluent levels in the observation pipes and to check for any
ponding of effluent on the ground surface. The ponding of effluent on the ground surtace may indicate a
failing condition and requires the immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equats 1l3 or more of the tank
volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and
disposed of in accordance with ch.NR 113,Wisconsin Administrative Code.
A service report shall be provided to the County Zoning Departrnent within 30 days of any service
event.
SWrt-Up and Operation
For new construction,prior to use of the POWTS check treatment tank(s)for the presence of
painting products or other chemicals that may impede the treatment process and/or damage the
dispersal cell(s). If high concentrations are detected have the contents of the tank removed by a
licensed Septage Service Operator.
System start-up shall not occur when soil conditions are frozen at the infittrative surface.
Page 6 of 7
Do not drive or park vehicles over tanks and dispersal cells.
Reduction or eliminaGon of the following from the wastewater stream may improve the pertormance and
probng the I'rfe of the POWTS: antibiotics, baby wipes, cigarette butts, condoms, cotton swabs,
degreasers, dental floss, diapers, disinfectants, fat, foundation drain (sump pump)water, gasoline,
grease, oil, painting products, pesticides, sanitary napkins, tampons, and water softener brine.
Abandonment
When the POWTS fails and /or is permane�tly taken out of service the following steps shall be taken to
insure that the system is properly and safety abandoned in compliance with Wisconsin Administrative
Code SPS 383.33;
-All piping to tanks and pits shall be disconnected and tfie abandoned pipe openings sealed.
-The contents of all tanks and pits shall be removed and property disposed ot by a Septage Servicing
Operator.
-After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void
space filled with soil, gravel or another inert solid material.
ConGnaencv Plan
If the POWTS fails and cannot be repaired the following measurers have been, or must be taken to
provide a code compliant replacement system: (Check One)
" The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a
soil and site evaluation shall be performed to locate a suitable repiacement area. If no replacement area
is availabie a holding tank may be installed to replace the failed POWTS.
A suitable replacement area has been evaluated and may be utilized for the location of a replacemen
soil absorption system. The replacement area shouid be protected from disturbance and compaction
and should not be infinged upon by required setbacks from existing and proposed structures, lot lines
and wells. Failure to protect the replacements area wiil result in the need for a new soil and site
evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
A suitable replacement area is not available due to setback and/or soil limitations. A holding tank
may be instalied to replace the failed POWTS.
�'W.P.f2NING!!
Septic, pump and other treatment tanks may contain lethai gasses and/or insufficient oxygen. Do not
enter a septic, pump or other treatrnent tank under any circumstances. Death may resutt. Rescue of a
person from the interior of a tank may be difficult or impossible.
POWTS Installer Septic Pumper
Name Gerald Frcemel Name Scott Poppe
Phone# 715-558-1138 Phone# F(715) 634-1450
POWTS Maintainer Local Regulatory Authority
Name Jays Septic Agency Sawyer County Zoning
Phone# 715-558-1138�i��� Phone# 715�34-8288
Page 7 of 7
U'tU'� 111+�,i?1E * � ,� ' r ,� si,#. ` � � , � �w . � � �/ �-�,
t . .r v , Y y j 'y�� �� '���y��i r e t' 4�3i � , ' �1��. �,�+�++� ' '�
,� � 4 ! + � �'��hf �pt'a� ,� ; _ � ;.
,�a✓� �r r. � "�y C" �;r ,q.er t4�)i i " k� �i ' ��- c�L�} < � �.� � � `.. '
,4.1 8 � � ��}�{ y �_ �� + - .��� � � 'f. R�
� t .M" �y� 9 � �Ftv� l .1""
.._yyJrf'Cw�..��'�1 t . ,�„ � .�t'£li`�. � . r - ,����� . _ 1�.1� � �y+`e ' ..' �
:�d`+' . .- . �g i ��" ` '� a I c - '! -.!.L .in �� � ,a,.,��
r
� ?."i` � .�.. � ]aA il `��'n . � � f.Jx}�'' �i . �, + � �4"'" , a_ S � .
�. ..'�, ¢,.' i �1. . i+yr.% �,Qk} 4 - r ` _ � � � �' _ y.�} \ a
M,i�4z: � . �r ,f�� � a �". i 4a . . u �� 'ti'��' � T _^ : j s : �
r��, ,'E -:''� �_-t �.Ij��2 � 7��Z"`�°e .k.r� .`1y��� '� ���ec.�,r. a `��• r-- � �, �i'y��r���+�� .
� . � '� � - L. ^ :l 5i '' y�r)`�`��� 1� , CV'�. �,1: .'+"6�"�,�.'iA} �r % f� 1 ,�� `'` 1 �� _ � ^�'"yz'v. n +'i
R� ' � p�
— -�' - 1.��{� '+'y�,� �5 �'°r -� .+} ) s f'� "�[.• ,�y, i}�' °'' a
_ �� 'fs�.��� _•���C.i L'�f �:�y. y j�j¢�.CY,,� � �5�� ^y a � .! y\��. .�lG'D�h �,�, '*-r -
_ �j �: �� 4 � t� � ��.�� T; � �„ _.Y,� ►-'a.��5�' _ 3'�����j{',�_
!_ ��'•1 v' _ _ � iF '_ ''i�` .. �'})t*` f��./� _��t -� t^�d�'C�p=,j�f'
`, �� ,k5+�� � �• � � ���r `� —� T� � ,�I���� �� �` t I�� . .
f ! ��I + ,. M1 M i� $•�� I ��L
. �?! 1 � .� t` �+y r�. A#�t`t'St � ��.i' ;,o''� d's , �� +
r� � •..: � i ' 1'_ A.� p. .
- . . ��6 Y �C ' . h .
� �y� � �; �d , ,
�� �}�; `�^ '�yt �,y� . � �� �- , � - � �t .�.
J ♦
71 �
� � � ��' i ��} �����./'ys Ir : i + .
'� �7.r ;& �f 'i:ty . �. y tr,� . f_
1� w 11��� � .+:.'�l'�r IF �� t 4 �' + � . . �.. ':� � �s
y i : .a} .� -�sr' SY .� a' y' 3x � YA i is'. � w�a :.v�'� � i !J r� rj �'
��v. � _� lfc� y - �.. A ��'�tfi' "�tiiiy r.�� .���, ����5�1�? . �. .�y -E .6:"
E. r" h ' 'lTs ... �T SI' '..�i, �+Y_°� �`a r - ,[ ..f. JC'SH'...L� -34 .r —
. �" h �.-�� .9�-' �.'�� ty,�se� Ay-.�-�£ �R.r�"4'�?4rW F'P�,• ",,�}a ;�' .. �!
3��-�� ip'i 7 `6"P f .. �a � ''� f a �°i �:.r �r.y++.�� 'Cr-,r. -i , . � �.
�iJaiv��.r4.x � ♦ �il ii' h 'i� i;��1y,`'�Y +.'J`r.*,.'k ��r�" �s F�� �.`'L
-rs r �y� � f ��a � G�S�j�.,,_�p .r+ � t.�:/ .
;h",.� '�y�� 54," �•` �'f S�}���+", "r"���'�yTY_ y Y�������. �� .t
� � � 3S ',-�� �r� ,1{ �p �
�T.,4j a '�S+ � .r 1-'�'� sS ._ " { � s'fi.
� .y,'*t! � i L r ,ar i ���.J�, .����� �=�3+.. r-X rap, ty .
atil
. � i T jy2�;` CT�$ �":
a � �� �� t` �{ � �� r ��ti� —�J .�. '+ wk.. � y.,.�yfr�y�lJ
If.�t � � Y S_ V
� � ��`x �» � • �.yl �•� � 'k1 ��_��F ��`r�t��� u'�edF��'i ' � � � . tiJ�.�,
� ! �' L
��'�(-b.. . ,� _ y �11'��� �':i.. .4�,✓"t r,.�ye[�s. �-r y,�y�=,�Rt„�„„�' f�.,� �, 5 ,, � r e�•.l'": ,:
� . ��r
t � >�' _* ,�� _ �� ir . _ F # ` � �- i
�' �
�-� � k1 a� W '�'�- 't. �' ,� ' , Cj
..t .1.: -� ��� e ,�:.. .�� . �� ��-r
• � 1 j � t YT�� �, { r .—r..� .. ?LL�/"
��� � '�,�t5.�' '�`" �""FaF"'�� '_ ' � ` ,t'- '' ..
. _
�i .
�.. - ��: +��. � ' �� � . .
v i
,. ' �,`` `�''� � - � i_e� r� . �: � ri, ��I-:�.. — ^+
r.s. �. i -��r`��.1.�ye�5-�'t�' ,al � �,��ry� . � '� ;�, '�.f. �� .� 1�#� �
s�x� �.,r tl'�� . � � _ � i � �,�T ra���. +/!'�,.]ds�`� a t� +.-.i 9,�4_�� t ��.� �.,y 1 • �
" £ 'F � .y�� ' . � s ' �y� �eix� ,�'";k�,r�.�-.Y� .�� � }. ,G " " J. . � .
� i� �i�� y� . �S .A�, Y. 'r ���� .�6 � . � t+ �7 . �Y�X� � I^l
�� '
� � + _ '_ti� LL�,F. S ';.. . � � �4 } : �T � � � � .. - :�'t � ' �,.
!�l�'�i,w�� v�� ' .:a f.yA,�a y�t� t '- .� � � ��'1 ,•r — �, ' �_[,�i� a i � . E� ���,;� I � . ��.
,, �
+.. ��"„ ..T ��• _ .. � ' s ?S .4. �.. �'.. .
{ 1 .}} ~ �' S^ �" 1 �k ,��� - l 's �F +A. � F .• - 1 '1 _�� (/ �
,+..e 1 . :i .�a,,ys� �r 'b..�..� '� �{� �� pkr�.rtrl �. � - . . � �
,R�4 ' ' '- s;-,,`1.,e[ '.,r�t t7,` _i� s-`: r t Ti; � :� �� �.y,, ((�
x " .�� ui ^ m '�$" �,7{'�'r`.#R��" �`� �1R�' Ir y � � Y i .v C0. 1P' . . a'fT.,. '
y �a�s�i��''�' � � v�� .r1� "'1 � _"' ."`ild } � � ' �r-+.� �� .. J
il� � . - �{ �- _ g �, e '� I I �.¢, � � � 'c . . � �1 £�
� �� I � �. � � _ � • _ �� ,
�- �� ��i� .1, � .' � � `�'C"�'^4 �� . .. �' ' Z
.Yi a l Y '+� 4i . � � .i� j
„���# ��^ ��•��. �` �' ��� Y � '�w) �15� �;tt ��-� � �i � �,��.�' t� .
' -�}iY `� 5.�i � ,s� !r A 5,F . �:l-1 . . . . ' �
'fL y �f.. . -]' 1Y�. ` �[-` ,..� , •. '�. _ � '�A. - h� _.."� J . .
'��y�t 4� �,'���L'�� �.� QF'� Y ' ' 't ., r ■ �`a y�. � '��•�� . -. . .
�� ta' r" ■ - �i ��✓ �! �'Y' � �, �f �' �5r r ,� f �4\�+ �'':'
,�. � < ... � �.; `�rs �1 4 ' �'!' . �� � v� � ��.. � - , .. . k_ _l�
'�..5 f���It> .� ' _ " �`_
S � , .. : � . ,• � ='lC ,� - � `�. . . ��' i' I ' � �ir, ,.r :• � . i..
jf ' ,� � ..�lr". � - ' � yy �
�r �'� �. y� f y++�� � r� . . . _ . .
" i� ywt� t'+�'_ e i J r � -� +� �� . ' . ' 1 . . '� . ,
"P�i'e� T�� . . �!' �. . . _. .
�"�- 4 � � _ ��- K�� jj � ' �•'`i
� •.� L�� � ��°� ,�� �� � ! � . � �,q, is ,, � .. "
~ • � y[` � � �S� .�' ' �� . . ' �e .� -� �.•1 ' . . � .
����,��1ry�� 1,(.`�� r � ..' � •, ��`..� V �� � � ,y . �-'� . .
1� , l "i O b' . . .
Y ` .k . �.. .,y, t
I� r�.�,'}"e�. �J}. . ,r ,_4, ,�,., a,: �, ',
IIL �3 lr^ .'�:� S� ♦ yF •�: � ..ti •g . M •1.}`. 4� . 4; . `' _
`1r�� - .r . . '" - ..k cAir� � . h„ � ' . '. . , .. .
{�9:..�� . �'�� � �. . . . �:�C °t.� r,.x � �.. � . .
. • ,
- � ..�t: t5 ". �.. ..._
�4.. r .p^.,`r'� .�,�: ` .�*y. e �,,;'�a' .���ae #: -,�- � . :�„ . . . _ .
y. � �t � ` •' g . _- :�- � . . .
i '�`�
f��_ .�t� F .; ^ � "� I ,, r��. _.�.�
, �
.�; iShJ. �i!} �, �(i�ii �'l��:i �IL _ � . L _¢4�y {�� ' . k;� . . . .
r '
w . � .
' �... 1�* a_'. -� " . " � .' . . . }�} � r .""} riY, i{i 1 s: P-�+ +��. _
.,.� ',. '�. '. �- 'i �'�. - I... . ! '•Ry �+LNr� . ' � .t �i`Ir�- .
,�t;••`-� � �.�
s- , ,t , _ '. - ' ' I .ti� � ':. r. ;Y . , �!�:
- "V ��.: rs � '.' -.� . t i ..
�: " ' '.. '_i � i-W �' � w.. '� '^ �..�II�.. s'+y�� "'>..
7M�r .�'. ' "' , tt � 'k � v.F:" � "' i w �� �+ `ti. 31 } "
' 4 'Y� � f � �l 1 . � e'���T
� � '� � . K'_ . . 1 � C/ + y "�' 1.
� + � ' tii� � � �� ,. � ..� �~ � ' M \l e�
i4.. f'� �}w4 ...� t �.i` y �°Ati' '"y�1��Y`. "� �^ 4ah'�_ � � "' '7t l � t �' p.,,:
4 : h � /�� '
_ �� `-� � r.�t`!�• ' J y� _�Y.F F � '�+-� -M _ -� `�R �.�y�" '.. v . 'Yp.� { �� $ ,"' ' r�'t a �
,y, � �g, �;
_ i�y��,1�, #'«�*�h'�.la.�.- ��Jl��� .�� iF +l;'p�, �r�9'i,.-.r' + � 1�; F" .` SS �J' ✓'�.�:: � .�''�.
� f A k. `�� �
__. ` t] .� ��". � 'o����'a.. '4 4 ,?�� 6� ;,,, } *a �' . � - } } 4 '�,� i';.. '� 4':.s.
}- �y� '�� � tiy� 4�- �� ay_ ," ,.�V���}• � 9 Y�' . ` �� � � '� 'Y�yi.r"t .'� i R. -.
��_� �'c � j' "_`�°4,"� _ .�:' j. ^ •F '�' �� � �.
__ r ��. � _i. , i s f�' � � �. 4 t. f r'� �_". �ta q.� y,r, .�
�""�-� , c'. �1 ti'4. '� I i�c-ir'tivq�.," � ♦ �.4 r�a i �,y ,,.� `t )
� �� �7 YGtV " ,ks� � .'�� �`, �tl�T � ��:£� �!.:� h:� ��.� li�. � ..
��' e� "��a t �• ` �
♦ � � �j . i {
1 .�f 4 � ��7�1f� .. t ` ..� h �� t`� y._�. � r ��
Y \ �: ' a .
�4 � "ti 1+�t ��� �.+� s -F-�y �,..R � � t��,ji�' {��4Ft,t �+? . � �lb'p ��.' �_ '.
� � :-. �.. {- �1, r .�t 't � � n' F. a I.i "l1'f•'. �e.�i. ., �.
". , �'�9� :.E�:;.' � � .�¢ , + t. � .:. a��¢�4 i�� }�.c r�;.� '':� " r �.�' .�
y: �,,,. �^�`tr r � S' s �� ;� r '
i��. -�. �� �b a, ,.. ''� �'Y y +� '{ , ,
A � + � rr.• - 2� 4yrc -� � i "�`"gYS.�. , '�� - ' �,� ��41: '°
y - , . . '
• �
` . 4X 4 ;y��� , y� � : �Y t <'�y�g. '.; � � 'r �i�` �.
" '� .. � . '� S °[ � _ p,l � .
� �
� �yk � � `� . +� ':t�`� '�✓.'4; x "r.'< x �.` �t _:' y, . ' �#.,t�,�'.
;�7
1 .t. I�t� � 't �_ '. .1 " �p y t %�ti. i( � �!�'{ . '
- � � . , 5',�, t y� 1 t
_ - 4�
, . �„_. �. '� � �ry� t .n� 5 . YW� p' r �• � 4 R.
+ � ��`S ' . .� :��,y�, t�� . M. � ._..
� �� �r } 1 � +. �' } �..
_ � .� -1 _ 4 ..'n:.M`.� 6 I {iav �.t' � Jlr�� t �•� �. ..
$� .Ay� t �y�
�� .��ti,, ���� � �i - � � �,; '#`+ 1 '
��: � r _ f}�,•. � � 1� ��4 � "' � �1 -_
�Y
i
���
� �'``�-; PRIVATE ONSITE WASTE TREATMENT county
-�� o$ � SYSTEMS SaW er
��� � PS � ( POWTS) Y
`"'F>�,,"..���%
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �. 3 .—.(a( 2
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J �
Permit Hoider's Name: ❑City ❑ Viilage ,�Town of: State Plan Transaction ID#:
��s�.W�-\S�=� �t �
Insp BM Elev: BM Description: Parcel Tax No:
�oC5,a' `�C� ��c��� . ����� 1ue�w ,��'►�1 0�0-�c� (..a 3 - 31�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic e� �^� }�` (Uda Benchmark dp,��
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet y5;3 �
TANK TO P/L WELL BLDG vENrro ROAD C.r2 /�
AIR INTAKE ��`(3 !
Septic NA m e,� o..�'�'^ 9�' � r
Dosing NA Installation �
Contour �•�o
Aeration NA Header/Man. �t Y s�
Holding Dist. Pipe
PUMP 1 SIPHON 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 W L (o�( #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav 4� Conv ❑ Aggregate ����,
INFORMATION P/L Bldg Well Waters Q GP � Chamber Model Number:
❑ EZFIow
CELL TO �- D �-jb �►-Sb� ❑ Mound o Other �Y fi —
- — -- -- - - ____— -- _ _-- ---- —-- ---
DISTRIBUTION SYSTEM x Pressure Systems Only
IHea�der/Manifold Distgbution Pipe(s) -- - p � X Hole Size X Hole Observation Pip�s
Len th Dia � Len th Dia S ac ' ___ '� Spacmg ❑Yes ❑ No j
SOIL COVER
- — -
fDepth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center �ell Etlges ', Topsoil �❑Yes ❑ No ❑Yes ❑ Vo
COMMENTS: (Include code discrepancies, persons present, etc.)
��s�I I� ���� ��3
Plan revision required?�Yes ❑ fJo ��j� � �-� � � i ��� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL C�MMENTS AND SKETCH
SANITARY PEAMIT NIJMBEA:_ .2�__�9_�.,
� . , _ , . _ : _ __ _ , _
_. . _ �
� ����
8�
��,,,� 36��
o��
NQ'� � ������
Y� ���b
�
�
� p
�
\ �-�"gI - � `,,,�L`T-�
. � 3,� ���.,�
5� 31 7�
• •
��
�' ,l
�� b�3 iv �� QK+ �C ��o
�
b
�a�,`��
'�a
��