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HomeMy WebLinkAbout032-114-00-1100-SAN-2023-198 � �,,, cn � SsFe(y and�gs D'rvision S o.y w e r � �g_�`1'_� 201W.Washir�gtonAve..P.O.Box7162 samtmyPamicJ�r(ooee�nim6ycb.) Z Z �n `�=��' Mac�n.WI 53707 7162 � '-�,�,-,�.�s' s� �S�l)�I � � / W �a� � Sanitary Permit Application '�T�''�°�` � m�wyn srs�sia�vru.wam.coae.�ormB�m��x�� u�a���ea�rn��x�nypramm�s�sm��arowrsa��oo �anaa���a�aa�e��s�-, me Ihpa.�t ocsa'ty�ti n�em�t swi¢raamat rotam�m�wo m'��v x amn foc sa�mr m�eaBh�e ' iaw,s t5. i � StaS n� I. 'ratiea Inf�matiea-Pkwae Priat AII Iafarmatjoa !-/-3�g`Z 1::..:�c�C.��..y u�3 Rr ProP¢g'Omia's N�e Pmce]� 37 �1 s r t �.�. i7•., t�3�•i i y'�o`u oc P+operty Oxads bfsil:�Ad�aa . �Y� lc FS 1 1•1 Z t t�uF i•+� t >> (�e I �t�.1�`� - � c�.�c� ��� z;pc�- `��x� s, x,s��� ����.V b, c_�{1c-�S�.c� _ ? �3�I� R 3 E II.Type of Boit�ug(c6eck all d�at aPPtY) lot x ���Z�y�,�—,��� 3 I J I—/���— s,�•�� � Cea..-a�rsLu ❑ram;dc�Q+t-�u� p�y� ❑SmmOwnrd-Dsmlelse �M��e ❑Vt�ageof � f�Townof l.v�ro=�:c,.. 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'.� ,,.�.-'tv S:`�._. .._ � __ .. ___ - _ _ . �;-; / -' / -- � : �-;` � \-_�. - ��- - : � : - ;2�` . : _; �. _ "_ - ' ' i ��-� _ �;�a � `� � :�� 'y` �i����1 12v 1` _ ' $_� : J�1 V� ?��� . .� '7:'� _.� _�:�Lr�- _ ! _L'.:L ��'s i' } ' ' � '� _ f-� - �`�.- — — -- — — —' — — '�_ _ - - -- — .F�= " ' - - ' - - -- _ d- '_ . : f ' ' ' ' " y. � _ _ _ � - ' �' - �� � 'WiYir` '7 �� s � � �',,�']�.'� '�]�'���L 1 N S T�A►LLAT 1+�3I�1 �1'�1 S T i�U CT��1�1,5� fnn�vi�bm in Ret+nR.Ar�inEpr .�, �he�• P L-5251P L-62 5 F 1 LT E R &R'�f�lwiluprMl�+4fl AG��luor�d'Ra��{oklnq Pt-525 PL-625 FEATURES & BENEFITS Feafi�res & Ber�efi�s: � � � • Rated far 1 a,000 GPD �".'� ,� m.� ��,�._. , >:�� � �;�� . PL-525 = 525 Linear Feet of 111�'" Filtratian . ; ���� ;�� PL-625 = 625 Linear Feet of 1/32" Filtratian .n.; PL-�25 Pt-s2s .Acce�ts 4" and 6" SCHD. 40 pipe The PL-�25 62� Effluent Filter shauld aperate efficiently ' �Uilt in Gas Defl�ctar for several years und�r norrnal canditians befare �q,�tamatic Sh�ut-C.)ff Ball when Filter is F�emaued requiring �leaning. It is re�cammended that the filter be cleaned evera/time the tank is purnped ar at I�ast e�+e�r� .q��rm Accessibility three �rears. If the� installed �I#er contains an �op�tianal alarrn, the owner will be� notified by an alarm r�vhen the •Acce�pts P'VC ExfiensiQn Handle filt�r needs �ervicing. Servicing shauld be don� b�y a certified septic tank pumper or installer. v � � m � 0 � { � f� c., � . � � PRICE COUNTY ZONING � County Normal Building, Room 205 1 Q4 South Eyder Avenue, Phillips, WI 54555 � � ��� (715) 339-3272 � � SEPTIC TANK MA.INTENANCE AGRE�MENT � � Owner: � � � � :' � � �� Address: 1 1 i 1 �c i �'��-(,�,� s '�" S � ; �ca i � � Legal Description of Property: � �� v « s 4'ti z � -•-s - — �4 �z � � a 3 � ► � �coo ; , � � Property Address: � ' � S � � `�' ' ���'" i"� � 3 j3 �� � `� — Maintenance of the system shall occur within three (3) years of the date of installation, or within three (3) years of the date of the previous pumping/inspection. Pumping or inspections of the treatment tank(s) (septic, pump chamber), and dispersal cetl(s) shall be conducted by an individual with one of the following Wisconsin licenses or certifications: Septage Service Provider, Master Plumber, Master Plumber Restricted Service, POWTS Inspector, or POWTS Maintainer. Maintenance activity sha11 include the following: • The treatment tank(s) shall be pumped by a septage service provider within three (3) years of the date of installation and at least once every three (3) years thereafter. Unless, upon inspection by a licensed MP, MPRS, PI, or PM, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. • The owner of such treatment tank(s) shall provide the Price County Zorung Department tl�e date the tank was serviced, or a copy of the inspection report verifying the condition of the tank(s) and dispersal cell(s) whenever t1�is information is required by the County. � Reports sha11 be signed / reported by the properly licensed individuals and provide credential nurr�ber. • When the title to the property is transfenred, a copy of this agreement should be furnished to the new pzoperty owner(s) This agreement shall be binding o� ali assignees and heirs , � ,�� Owners signature: - y �L,�.�r��� (_� ���� Date: �`���� — , � NOTE: "*This A�reement is not applicable to Privy or Holding Tank Owners. / n � � �� �,, ' "`-'``c PRIVATE ONSITE WASTE TREATMENT county '� � SYSTEMS Sawyer �4� $ps �J ( POWTS) �h �"_.�=,% '""�" INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) I GENERAL INFORMATION � 3�- 1�� Personal 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#: � ✓�»a7��o� V`v� �M� �n1�v�T'�� �� Insp BM Elev: BM Description: Parcei Tax No: l Q O a C7( ��Cc�v�.0 . `TZ�.r C��l� �o�_ v� � - I��^��'I�C� �j TANK INF RMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS E��EV Septic ��c Benchmark �pp,pt Dosing Aeration Bldg. Sewer 7 3 � Holding St/Ht Inlet q � TANK SETBACK INFORMATION St/Ht Outlet � ,r'j TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic fi-�.�-` k-�. �'7 �{-�'� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding Dist. Pipe PUMP 151PHON 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 #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv � Aggregate INFORMATION P/L Bldg Well Waters o GP � Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other ___..— - __ _--_ __- - - - -__----- -- --- - _-- DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifold Distnbution Pi e s X Hole Size X Hole Observation Pip�s Length Dia Length pO Dia Spac 1', �Spacing ❑ Yes ❑ No �'� SOIL COVER Cell CeOnter �eI�ItE gesr II T�opsoi�f ___-- ❑Yed/SO No T ❑eslche❑d �� COMMENTS: (Include code discrepancies, persons present, etc.) ��(�Q ��� r�� �' �`,�, !�Q(�, av�ly ( Plan revision required?0 Yes❑ PJo ���3 � � �-- �� �� � ��'�( � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS ANO SK,EpTCH SANITAAY PERMIT NUMBEA _�._�--�`�O l� / `� (�� �aGY� � .�� � � c�� �o.{ � �I�c' \� I '7 �� .� ���� . , v, �-, �� a� � , .�6 ---' � �1S` � � N 6� � 5\��.1� � ��Yr's� on,��l-,��^�- . ��5� O �b , .� g � �r s � �� I21�1�`�l�~9 � � J� � e r a i F�-!='_--