HomeMy WebLinkAbout014-841-07-2304-SAN-2023-253 !
_ '"""�%;; Department of Safety c°°"Ty s �
�� � = & Professional Services, �
= � _ . Sanitary Permit Number(to be filled in by c
,j, `, �_ � Industry Services Division
� (� S I G: �i y y.�
\k �... ��\ �
Sanitary Permit Application State Transaction Number �
;
In acwrdance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit �/1
is required prior to obtaining a sanitary permit Note:Application forms for state-owned POWTS are submitted to Vroject Address(if different than mailing a (�:t
the Dcpartment of Sa{ety and Professional Scrvices.Personal information you provide may be used for sewndary
purposcs in accordance with the Vrivacy Law,s. 15.04(I)(m),Stats. ' �5 3y N �00 K�-h
I.Application Information—Please Print All Information
Property Owner's Name Parcel#
1�:����� � ; ��ti- s�r �-07 ,3oy
Property Owner's Mailing Address Property Location
91(7 SurS�� Govt.Lot
City,State Zip Code Phone Number
��(" M 0�J`�1�'C��r�� r1 Z y9��) -�'�w Y<, N�1 y,, Sec[ion C��
IL Type of Building(check all that apply) Lot# 'i' 4� N R £-or
�Ior2FamilyDwelling—NumberofBedrooms � 39 SubdivisionName
Block#
❑Public/Commercial—Describe Use
❑Cityof
❑State Owned—Describe Use C5M Number ❑Village of
�'S M f# 70 c�S� �own of__�'/?I`0 0'�"
v.��. .�(.
Itl.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i
a licable.
`� �,New S stem
y ❑ Replacement System ❑Other Modification[o Existing System(explain) ❑ Additional Yretreatrnent Uni[(explain)
B' ❑ Holdin Tank [n-Ground ❑ Mound ❑ Individual Site Desi
g � ��,,,e,,�- ❑ At-Grade gn ❑Other Type(explain)
(conventional)w1G;F{�
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ist Previous Permit Number and Date Issued
❑ Transfer to New Owner
F.xpiration �-
IV.Dispersallfreatment Area and Tank[nformation: ,y x 7 ' a yD f 6 eont�
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(st) Dispersal Area Proposed(st) System Elevation
ys� � . b/�. a a�a /aa� 3��/a�� �r qG.o �
Capacity in Totel #of Manufacturer
�
Tank Information Gallons Gallons Units � � v � �
New Tanks Existing Tanks � o � � Y a A �
�'Op'1�j� a U v� �, rn it. c7 a
Septic or Hnlding Tank � 'O ��e r ��
Dosing Chamber `�� �.. 4OO
V.Responsibility Statement- l,the uodersigned,assume r ponsibility f r in Ila 'on of the POWTS shown on the attached plans.
Plumber's Name(Print) PlumbePs �2nature MP/MPRS Number Business Phone Number
. "
Tr�o��;s u N���'e Jd � �Saa� 9 7/S-G 4 -977
Plumber's Address(Street,Ciry,State.7ip Code)
J y3 y 6 w .s-f�,.� 2a�.a �� 1-�.. ��r d wr s�-�a Y3
Vt.County/Department Use Only
(o,t 2 Permit Fee Dale IssucJ Issuing Agcnt Signalurc
Q�-Ap ro ed ❑Disapproved �/� � ��/� �
❑Owner Given Reason for Denial $ ��•� '`���`�'�' '- I<��'�'�`'�''�-�-�'!/�
D � �� �.:
Conditions of ApprovaUReasons for Disapproval �` �,,,.i 7
�._j�
� � - 'i�
�� ' �;,y` Date � � ��a3 .�.. T 0 2 2023
OC
Chk# ����
____------
CsT �.3 - � � 3 ,�, �� 5��=��o�;«n
"^��'" ��'� ZONINGAD��!�N1STFlATlON
,,,, �:-r_...._.__�..�_____ ._
Attach to complete plans tor the system and submit ro the County only on paper not Iess tt�an 8�rz x I1 inches io size
1� 3�j
NO R�FUN�s AFTER
SBD-6398(R.03/22) IS$11E OF P���1 I
GeoMat IN GROUND AND DOSING DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
er no , _
Project Name: Mitchell Family-Brook Ln
Owner's Name: Mitchell Family Trust
Owner's Address: 910 Sunset Dr
Iron Mountain,MI 49801
Property Info
Property Address: 11534N Brook Ln ___
Legal Description: SW NW S 7 T 41 N R 8 W
Township Lenroot County: Sawyer
Subdivision Name:
Lot Number: 39 Block Number: CSM#: 7025
Parcel I.D.Number: 014-841-07 2304
Plan Transaction No.:
ex ages
Page� Index and tftle Page 9 Pbt plan
Page 2 Data entry Page 10 Pump Curve
Page 3 GeoMat dist.cell drawings&calculations
Page 4 Lateral and cell cross section
__—__
Page 5 Management&contingency
Page 6 Maintenance 8 specifications
Page 7 Tank cross sections
Page 8 Distribution media
Travis Butterfie License Number: 652879
__-- — _
Date: 09/29/23 Phone Number: 715-634-8176
Signature:
Designer Stamp: State of Wisconsin Approval Stamp:
Designed Pursuant to the
GeoMat In Ground Component Manual April 2019 Version
Page 1 of 10
In Ground and Dosing Distribution Component Design
Site Information
R Residential or Commercial Design N ISD Required?
300.00 Estimated Wastewater Flow(gpd)
1.50 Peaking Fador(e.g. 1.5= 150%)
450.00 Design Flow(gpd)
1.00 Site Slope(%)
96.08 Prop. System Elevation(ft) Santl&Nafive soil Contour
41.00 Depth to Limiting Fador(in)
i 1.60 In-situ Soil Appliration Rate(gpd/flz)
r 97.50 Lowest Original Grade Ele. In System Area(ft)
� 98.25 Highest Original Grade Ele. In System Area(ft)
96.47 Limiting Factor Elevation(ft)
0.67 Depth Below Grade
istribution Cell information
325 Cell Width(ft) � 1 Number of Cells
� 2.00 Dispersal Cell Design Loading Rate(gpd/ft�)
2 Intluent Wastewater Quality(1 or 2)
istribuHon Information
E Center or End Manifold, DisL Box or Drop Box
7 Number of Laterals System dosed Y
0.00 Lateral Spacing(ft)
6.52 Forcemain Drainback(gal) Does the forcemain drain back? Y
0.00 Forcemain Filter Loss(ft)
2.00 Forcemain Diameter(in)
40.00 Forcemain Length(ft)
91.00 Inside Pump Tank Elevation(k)
3.50 System Head(ft)x 1.3
5.85 Vertical Lift(ft)
1.39 Friction Loss(ft)
1074 Total Dynamic Head(ft) Designer must ��'� � -.t. �. ��.^..,.
51 52 Minimum Dose Volume(gal)
25.00 System Demand(gpm)
Manufacturer Infortnat on `
Treatment Tank Infortnation Effluent Filter Information
1000.00 Septic Tank Capacity(gal) Best Technologies Filter Manufacturer
Wieser Concrete Products, Inc Manufacturer GF10 Filter Model Number
Dose Tank Infortnation Gallonsllnch Calculator�.-:�-�onaq
602.82 Dose Tank Capacity(gap 602.82 Total Tank Capacity(gal)
�1.82 Dose Tank Volume(gaVin) 5100 Total Working Liquid Depth(in)
Wieser Concrete Products, Inc- �Manufacturer � 11 B2�gal/in(enter result in cell DoseTankVolume)
Project: Mitchell Family-Brook Ln Page 2 of 10
In Ground Plan �ew
Il � cC�IlIl c����I��
� °o�o o°o�o°o°o o°o°o�o 0 0°0°0�0°o°o�tr�o°o�o�o�o�o°o°o�o°o°o�o°o�o�o°o�o�o°o�o°o 00000000a�00000 .
' 000000000000000000000000000000000000000 0000000 .
• oop0000000000000000000000000�00000000000000000 00�0°0�0°0°0°0°0�0°0 .
.' o�o�o�o�o�o�o�o�o�o�o°o°o°o o°o°o�o�o�o�o°o�o° y�, � o00000000 00°0�0°0°0 .'
,. o000000000p0000000000000Q000000000000000000000 ��d`e�li'a�. o00000000 0000000�00 .
_'_ 1
ons
I ft A 325 ft Basal Area Required 28125 ft`
K 1 ft B 70 ft Basal Area Pro osed 367.5 ftz
S 0.00 ft L 72 ft
W 525 ft
Basal Area Calculation GeoMat Dis ersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
450 1.6 gausq ffmay 450 2.00 gausq tvday
Total 281.25 ftZ Total 225 ft2
Pro osed 227.5 ft2
Number of Cells 1 GeoMat Width 325 ft
Cell Length ft Lineal Feet of GeoMat Required 692
Min. Cell Len th 69.2 ft Lineal Feet of GeoMat Proposed 70
Cell S aCin 0 00 ft NOTE Min S dimension= 1'
S stem Elevation 96.08 ft
Limitin Factor 96.47 ft
Se aration -0.39 ft 2'Min
Directions
Play with cell length to get desired cell spacing length and width Remember system SHOULD be longer than i! is
wide. It must also Satisf basal loadin rate and GeoMat cell loadin rate
Project: Mitchell Family- Brook Ln Page 3 of 10
End Connactlon Lateral Layout Diagram
�
Hole spacing is every 72", 1/2"hole at 4 8 8 O'Gock,starting 4 O'Gcek 6"from end and
8 O'clock Holes at 12"from end. 4"Pertorated pipe may be usetl.
Lateral Spacing 0.00 ft Pipe Diameter 2.00 in
� OII 0 fOdE OII � _ . .. . . . . .. .. . . . ._ . . . . . .. .
�inichedC�nAc �V Y `� ` `1`1�`7
. . _._,. . _:.- �i1NtaCm
I ��� � 12"-42 eanra � I�9velLevd
0.67 ft—
4 ' ' ��
2in —► PtpeDli-.' ^ �%u , p�
. .. � Pipr �._
Top of geomat to be at or ��. _ _ _ - � �_GfDMAT
below onginal grade 1 I I 2 AS-n,f 33 e,.i I � I , I � I � I �
I I I . I � �g��S��
- _____NATIVE.SOIL=.c__�l�
------__--�_--=a�rs�`Ftiv
41in y
� 81VS 00 peS . .. ... . . . . . ...
waQn�c�
Re`e.e n.e.
I
I
/ �•A6�A
12"Mia .-{ jl �
42"Max. '"� I
IT.,nerianc i sm � ' -u.�n„
bDvsC I
t�'�pe � mv..ms.��
.e� , _
�: -- , �� _ , -
�raao�rcownl�'�', �ie .eu.n��.;,..
�'��i5-k�'snw co��e.�a:�;�i;;';'',';
96.08 •�1L-`
Projecl: Mitchell Family-Brook Ln Page 4 of 10
Notes/ Maintenance Requirements
MANAGEMENT PLAN
This private onsite wastewater(POWfS)has been designed,and is to be fnstalled and maintained in accordance with SPS 383,Wis.Admin.
Code,the in-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treffiment Systems Version 20 SPS-i W05-P
(N.01/01). GeoMat in ground Component manual Apri12019 Version .
1.This POWTS has been designed to accommodate a maximum daily flow ot 45Q,�9Rons of wastewater per day. The quality of
influent discharge into the POWTS ireatment or dispersal component shall be equal to or less than all of the following.
A monthly average of 30 mg/L fats,oil and grease
A monthly average of 220 mg/L BOD5
A monthly average of 150 mg/L TSS
Wastewater shall not discharge to the POWTS in quantities or qualRies that exceed these limits or that resutt in exceeding the enforcement
standards and preventatrve adion limits specifed in ch.NR 140Tables 1 &2 at a pofnt of standards application,except as provided in DSPS
383.03(4),Wis Admin.Code.
2.The owner of this POWTS is responsible for system operation and maintenance.
3.Defects or malfunctions identified during maintenance described above shall be repaired in conformance with SPS383 Wis.Admin.Code,
and the pertaining county Private Sewage Systems Ordinance. The users manual,provided to the owner of the POWTS includes the names
and telephone numbers of the properly licensed individuals to contad for such repairs-
5.No product for chemical or physical restoretion or chemical or physical procedures for POWTS may be used unless approved by the Dept.
of Commerce in accordance with SPS.384,Wis.Admin.Code.
6.If the POWTS is replaced,or its use discontinued,R shall be abandoned fn accordance with SPS 383.33,Wis.Admin.Code.
NOTES
Two EfFluent Filters to be i�stalled where possfble 1 to be installed in ST,and or 1 in pump tank in
order to insure paRicle size less than or equal to i/8". Filters should be cleaned once in spring,and once fn fall. Alsq strainers in sinks in
the building shall be maintained,so that solids and fats are minimized to flow into system.
A minimum of 2 observation pfpes per cell shall be installed. These pipes shall be located approxfmately at the end of each cell.
The plumber,or counTy shall see to it that a wpy of these plans including this page,maintenance folder,and maintenance agreement is
given to the homeowner.
This system may contain a dose chamber. If a pump,float,electncat outage causes the dose tank to fll,the homeowner should see to it that
[he effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could rause damage.
Contact a pumper or your installer if this problem occurs.
The homeowner is responsible for formulatfng a water conservation plan that will ensure the system is rarely ovedoaded. I.E.spread laundry
out over time,not 6 loads in 2 hours,while everybody showers,and uses the toilet,ETC-
CONTINGENCY PLAN FOR COMPONENT FAILURE
A. Septic Tank.Any stmctural failure resWting in cracks or leaks in the tank must be corrected by replacement of the septic tank component.
Leaks in the joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water-
tight.
B.Outlet Filter.The outlet filter shall be replaced or repaired when it is either no longer capable of preventing the discharge of particles larger
than 1/8 inch or when it has become permanently Aegraded by clogging so as to interfere with the design flow out of the septic tank.
C.Dosing chamber and pump.The dosing chamber shall be replaced if any structurel failure is found. Leaks in joints between manhole
risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water-tight.The pump and controls shall be
replaced when they are no longer capable of functioning according to the design plan_
D.Pressure Distribution Piping_Partial clogging of the distributfon network may result in unduly long dosing cycles.The ends of the
distribution laterals may be exposed and the threaded end caps removed-The piping can be disconnected on the ouUet end of the pump.
The distribution piping may then be back Flushed to cleanse any accumulated matter from the piping. II is recommended that the dosing
chamberthen be pumped by a licensed plumber.
E.Soil Absorption Cell.The discharge of sewage or wastewater to the ground surface is strictly prohibited due to Ihe human health hazard
created by the effluent.All faiWres created by surface discharge shall immediately be reported to the appropriate county.The pump shall
then be fmmediately diswnnected to prevent fuRher discharge to the ground surface via the soil absorption cell.The existing septic tank and
dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorption cell can be achieved.The
replacement shall be initiated only after any necessary plan approvals have been obtained from the
appropriate plan review authority and the required sanitary permit is obtained fmm the county.
Project: Mitchell Family- Brook Ln Page 5 of 10
In�round System Mai�rtenance and Operatlon Speciflcffiions
Service Provider's Name Butte�eld Inc Phone 715-634-8176
POWTS Regulator's Name Sawyer County SPIA-Zoning Administration Phone (715) 634-8288
Svstem Flow and Load Parameters
Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in
EstimatedFlow-Average 300 gpd Maximum60D5 30 mgl�
Septic Tank Capacity 1000 gal Maximum TSS 30 mglL
Soil Absorption Component Size 227.5 ft Maximum FOG 10 mg/L
Type of Wastewater pomestic Maximum Fecal Coliform 10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Ins ect and/or service once eve 3 ears
Effluent Filter Ins ed and clean as necessa at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test periodical
Pressure System Laterals should be flushed and pressure tested eve 3 ears
In Ground Inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a wateRight cap
and are secured in as shown in the GeoMat In Ground Component Manual Ver.April 2079.
2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMat In Ground Component
Manual Ver April 2019. Media is covered with an approved geotexti�e fabric.
3. All gravity and pressure piping materials conform to the requirements in SPS 384,Wis.Adm. Code.
4. Scarification of basal area is accomplished with a rake or other tool.
5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration.
Lateral Turn-up DeWil
6-8"Diameter Finished Threaded Cleanout
Lawn Sprinkler Grade \ Plug or Ball Valve
i Box �
y � Vent if� � ot Dosed
� Lateral Ends at Last Orifce Where
� Long Sweep 90 or Two
�45 Degree Bends Same
Diameter as Lateral
� �' _
�Distribution Lateral � Lateral Cleanout �
96.08 Feet
Project: Mitchell Family-Brook Ln Page 6 of 10
PAGE � t� �
GRAVITY-DOSED '— �F �
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4°9 Vent Pipe
>10 ft from
Building Eleclnral musi comply with
12"Min.or 20 fl above SPS 3'I6 and NEC 300
Eslablished Flood Elevation Exfena manhole riser as necessary.
(ryPi�l) Weatherproof
Appraved Junctian Bax
Vent Cap APP����ocking Manhole
IMPORTANT: ��m wam�n9�abei nuacnea
Anchor tank(s)as necessary �ryP���
pursuant to SPS 383.43(8)(g) ----co�d��i
4"Min.or 2.0 ft above
Established Flood Elevation
(typical)
�Airtighl Seal
Finished Grade �
' �uick Disconnect
18"Min.
CAPACITIES @ � 1•$2 galfin � . _ nvP��o
Depth (in) Volume(gal) , a �
A 35.8 423.16 — *� w�v �nPP�o�ea�o���s�m
Hale Appmved Pipe 3 8 on�o
B 2.0 23.64 A �j sora c�o��a
� (tyPiwl)
IC] 3. 37.82 �
_Alarm
� �0.� � �$.2� 8 _On
� ��� PUMP-0FF
* 51 � P°mP �—� ELEVATION = 91�83 ft
Pump Tank Liquid Level = in
° INSIDE BOTTOM
Force Main Diameter= 2 in c°"Ce'e
B�� ELEVATION = 91.00 ft
Force Main Length = 20 ft 3"Appmved Bedding Matedal Beneath Tank
Force Main Void Volume = 3.26 gal
[C] Total Dose Volume (TDV) gal/dose
�
(<02X design flow+force maln void volume)
Vertical Lift = 6.25 ft
PUMP TANK: SEPTIC TANK(S):
Volume = 1000 gal Total Volume = 602.82 gai
Manufacture ser Concrete Inc Manufacturer(s): Wieser Concrete Inc
Pump Manufacturer: Liberty
Install approved effluent filter at the septic tank outlet
PumpModel: 253 ��a„a��P�mPwNe� immediatelyupstreamofthepum�tankinlet_
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Best Technologies
Controls/Alarm Model: PS Patrol Filter Model: GF10
Fioat switches containina mercury are prohibited.
GeoMat Distributlon CeN Media l.ayout
325 Cell Width (ft) 2.63 Sidewall to Laterel (ft)
Distribution Cell Cross-section Arrangements
-- _-- ----- - - -
n _ _ __
O Distribution Pipe
GeoMat is covered with approved geotextile fabric as per the their product approvai.
Distribution Cell Plan View Layout - Typical
325 Cell Width -A(ft) 70.00 Cell Length - B (ft)
End Connection Lateral Layout Diagram
.�. �.� �.� �., ....... � �. .� �.. �� ..� .�� �� �. ��:
. _. . -
�1'g8 e .
�i»:cheVi �r:�r1r � V ` �\Y Y '� `!`! `�
� �^�' v��'� -�- 12"-42"� gae�rd � LaLQalI.evd
� •. 1 •
�WR �Y .
p�p�,�y�, �, . 1 . � �hSt \ �`. - ..: F�
. ' .. .. . � Pipe '�--'� � —
�1• � _ _ . _ T � _� GFAMAT
� � � � � � � 2"AS'IM33 �+� I � I , 1 � 1 � 1 C�A��
Infil�ve Siufice
� - = - J =NATIVE.SOIL- = = - -
� _ � - - � � � � � � _. � _ � � .._ L��PF�cmr
See details on page 4 for number, size, and spacing of laterals.
Project: Mitchell Family- Brook Ln Page 8 of 10
CHECK BOX AS APPLICABLE CHECK E30X AS APPLICABLE.
� SOIL EVALUATION Scale: 1�� =60� � SYSTEM PAGE�
0 6o go �Zo 9 0 � 1 p
SITE MAP PLOT PLAN —"
PROJECT NAME: ��, v GPD
I 152 DESIGN FLOW:
�i 7�G��1 ���^t��y (�uS � Attach design flow calculations for commercial plans.
PROJECT ADDRESS: I I �3Y � Q/�� �`'`-� , Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
l N Sanitary Sewer �� ��� Yo/
BM Symbol: -�- BM Elevation: �v�� �' FT ����� y�
n / Force Main: /
BM Description:11a` I �� 0��
Indicate north by IMPORTANT:
Slope Gradient(%) Well Symbol(If applicable): � drawm9 an arrow Show ground elevation contours at suitable intervals.
of TBsted AI'ea: on the approprite line.
��oo� L�,-�
' � �M���et( ��,�C� 7%���f
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Afb} AbSorp+�a+ A�a Cans15�� �
� �a,.�o,e,,;� 70f� 6eorns� $9oD J
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LITERS PER MINUTE
0 20 40 60 80 100 120 140 160 180
25
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7
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20 6
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0 10 20 S, 30 40 50
GALLONS PER MINUTE
- �250 Pl R 1/17/201 R �iCopyright 2018 Liberty Pumps Inc. All rights reserved. Specifications subjeci to change without notice.
�L111115°
' ""``"' PRIVATE ONSITE WASTE TREATMENT cou�ty
,,,,,
,�,, ,
-"� o$P ,y', SYSTEMS Sawyer
-�,,1 s ( POWTS)
� � �:i.
' '"`^ INSPECTION REPORT sanitary Permit rvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION a3 r���
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(()(�n)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
V1n;�.� ��,,;� ,,.� �-�,�-�- `—
Insp BM Elev: BM Desc iption: Parcel Tax No:
�o�.o' N�� � ;,, � a'' o�k o��-SY(,o�-a3aY
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic N,;Q�,f � ��p.D Benchmark ��,oi
Dosing —cd,,,,,�po (..,�,�
Aeration Bidg. Sewer Q-j,3�
Hoiding St/Ht Inlet q ,s' g '
TANK SETBACK INFORMATION St I Ht Outlet ��, �-�
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic ��«� �,/ �,a, .}-��' NA Dt Bottom ��_3 �
Dosing � •� . t NA Installation p f
Contour �g •
Aeration NA Header/Man.
Holding Dist. Pipe a7. �
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface �6• �
Manufacturer � � Demand Final Grade
Model Number 35 GPM T.y C3 �7, ( �
TDH �Lift Friction Loss Sys Head TDH Ft
Forcemain L ��` Dia �� Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W (y L S #of Cells Type of System Distribution Media ManufaCturer'
SETBACK OHWM of Nav � Conv ❑ Aggregate G� a
INFORMATION P/L Bldg Well Waters °� G ❑ Chamber Model Number:
❑ EZFIow
CELL TO a-to� t o� N ❑ Mound � Other
-- -- --Y - �--- --- ----- —- --- --_ _----
DISTRIBUTION SYSTEM X Pressure Systems Only
------
Header/Manifold Distribution Pipe(s) ! X Hole Size X Hole Observation Pipe�
Length Dia Length Dia Spac I Spacing ❑Yes ❑ No
--- ----
__ __.
SOIL COVER
— - - -_____
-- — -- _
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges ' Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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� �0 3��� �- % �_ �� __ � ---
Plan revision required?�Yes ❑ No �` � I � I / � ��� �
L ��
Use other side for adtlitional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AD�ITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA: � 3- �5.3
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