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Home My WebLink About008-213-00-0200-SAN-2023-265 "'� "'�% Department of Safety c°°°ry `n I - Saw r �' � = & Professional Services, � �_ � � - Sanitary Permit Number(to be filled in b� , � '_ � Industry Services Division �`�>=�.r-.� � � f (c �S �; State Transaction Number � Sanitary Permit Application _ sa In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �' is required prior to obtaining a sanitary permiL Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing a � the Departmen(of Safety and Professional Services.Personal intormation you provide may be used for secondary purposes in accordance with the Privacy Law�,s_ 15.04(1)(m),Stats. �� L Application Information—Please Print All Informatioo Property Owner's Name Parcel# 6tn� + Na�c Ish� oos- a� -oo oaoo Property Owner's Mailing Ad ress Property Location / y C vY, �= Goar-tor-- City,State Zip Code Phone Number 1 �rG�WO t)C.'� l.J T sy a�� ---�, Section�Z II.Type of Bui(ding(check all that apply) ►-at# T 37 N R 09' W �1 or 2 Family Dwelling—Number ofBedrooms � U n�} # a Subdivision Name Block# I.�Al �c'NS I�ESOZT CONI�a ❑Public/Commercial—Describe Use �� City of ❑State Owned—Describe Use CSM Number ❑Village of � �own of��GJC��r-- III.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. A� ❑ New System �Replacement System ❑ Other Modifica[ion[o Existing System(explain) Additional Preheatrnent Unit(explain) B' �Holding Tank ❑ In-Ground ❑At-Grade ❑ Mound ❑ [ndividual Site Design ❑Other'Type(explain) (wmentional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Permit Number and Date Issued ❑Transfer to New Owner Expiration (.1v1� � [V.DispersaVTreatment Area and Tank Informateon: Design�low(gpd) Design Soil Application Rate(gpcl/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation a''� NIA NIA �+ 1i1 Nl/� Capacity in Total #of Manufacturer Tank Information Galtons Gallons Units a � o � Y m � U New Tanks Existing Tanks L o � � Y � =v c`"a a U �n �, v� u. U a. Septic or Holding Tank a O o v � � �.Y �-. � x Dosing Chamtx�r V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber�s Signature MP/MPRS Number T3usfness Phone Number Rora�� A � Tr aaLGs8 ��s-ss�z:y�'� Plumber's Address(S eei,City,SCate.Zip Code) 9 O S N S�-c-1-c (��ad o�7 1-� i,�rarn), W= S`18 y 3 V1.C u ty/Department Use Only �o q Perrrtit Fee Date Issued Issuing Agent Signature �A t v ❑Disapproved $ ��.� � �� i f �� _�n��E-] j,_ _ - � �� GvlJW1— ❑Owner Given Reason for Denial Conditi c2LA roval/Reasons for Disapproval D 11 � � � � �9 � ,� � �' ; � � .��:� 1 � ' `�1�.3�....,�.. � � A , Lhk# �� OCT 0 4 2023 GSTI�/� �. �r�„ba; 7j.�jzS.,__ .__.._...._..�__. _ ZON NG ADM NOTRATION Attach to complete plans for the system and submit to the County only on paper not less than 8�rz x 11 inches in size �C7�� i f�Q R�F�JN��AFTER sB�-639s�a.o3i22� IS�J�0�F'E��f1T Sawyer County Zoning & Conservation Administration 10610 Main Street, Suite 49 ��R Cp�� Hayward,Wisconsin 54843 �'1 .— -��fi I (715)G34-8288 .%�/� �'��I� FAX(715)638-3277 �P/ �(�� _� _ 1�� wwwsawYL'1'Countveoy.rng � � E-mail:sanitanan msaw crcciunty o��rg �I�°�� =� � =i�� Toll Frce Courthouse/General Information 1-877-699-4110 ��;�s I�2�� ` ��'= ��1`ON�� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �O /�/� Parcel ID# Oo S� - :Z � 3 - n b - � 2 0 0 IL Plot Plan: Property Lines � Benchmark BM ♦ Site Address �North Arrow Structure x Scale �Well �<25' to Service Road �Legal Description �Nearest Road Intersection �Setbacks to: Property Line, V�ell, Structure, Water bodies, Roads III. Required Plans: !� Index Page with Original Signature � Management Plan/Contingency Plan Servicing Contract Holding Tank Agreement Form ($30 to ROD) IV. Holding Tank Specifications: � Tank Cross-Section: Manufacturer: �''��e� Gallons: �� D( Tank Anchor Calculations [SPS 383.43 (8) (g)] �( Locking device, chains/locks �Alarm, electrical per SPS 383.43 (8) (e) �3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: �D Holding Tank Version 2.1 (May 2022-2027) Owner: �S�a �U) Plumber: �S �r Application Review Date: (o�9 (�c�� 3 POWTS Reviewer: �y` r�j� �� Name 6`��(� Rev. 4/27/2023 Credential# CONCRETE HOLDING TANK DESIGN Single Tank Optrni� INDEX AND TITLE SHEET Project Isham-Dalens Resort-UNIT 2 Owner Gene&Nancy Isham Address 1764N County Hwy F Birchwood,WI 54817 Legal Description Sec 07,T37N,R09W Township Edgewater County Sawyer Subdivision Name Dalen's Resort Condo Lot No. Unit#2 Parcel ID Number 008-213-00 0200 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Designer Ronald A Spreckels Jr Signature �k"�� Phone No. 715-558-6472 � License Number 226688 Date 10/04/23 Designed pursuant ta ',� Holding Tank Component Manual For POWTS(Version�9} h1•Y a�� SBD-10855-P(N.03/07) Version 7.0(03/12) Pa9B 1 of 4 HOLDING TANK SPECIFICATIONS � 2 Number of bedrooms Non-residential estimated flow(gpd) 2Cq0 � Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capacity (gal) Wieser Concrete Inc Tank Manufacturer W2000-MR Tank model number SJE Rhombus Alarm manufacturer Tank Alert EZ Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 13540 Ibs Weight of tank and cover 47.0 Liquid depth below inlet invert(in) 1.10 Safety factor 8.0 Maximum de th of soil cover(ft) 20505 Ibs Weight of anchor required 66.0 Height(in) Outside 27.3 in Soil cover req. for anchor or 151A Length (in) Dimens�cns 5.1 yd' Concrete counterweight 86.0 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished /vent cap junction � warning label grede IG box _� � — 4"mfn. 12"min. 23 in. Manhole and vent locations conduit � venl pipe 18"min. � tetherweight - � building sewer � -- - - � 12.0in. -- - - -- - - service inlel blind pluq aiarm on Note: All tank joints, and to seal joints between tank ounec openings and piping are Electrical as per 35.0 in. sealed watertight. All NEC 300 pipe and vent materials and SPS 316 comply with SPS 384. 3 in. bedding under tank. Tank is anchored as necessary to negale buoyancy. Project: Isham - Dalens Resort- UNIT 2 Transaction Number: Page 2 of 4 F� LoT I�� AN F�� 3 �_y [}c��ehs Co��os ua,T Ha - �a�Enis RESoa-r co�ZTO G2nQ � T,nhc� -�-5�4 �M SEt o7 , t3'7N , R09W I"16Y � Co Nw� F Tawu ea e��CwnrER, S�wy�RCo�,nrry 6��wood� W I sy8l� Pc�. 008- a�a-oo o� o 0 -��_ �sy _ 3s�o ►-�r - �000�.�. � .�{-abcwun�e Noid:,,� ra„x Ihac+t by Wt[,gcr �a,.�ery�Glnc . O i0 �S y0 S'� a0 _ KEx�S�:}•g TanKrS ia be propa�lr a�w.ob+�.tA and jI _ d`Sco.�nieFtd Cr�rw �,.JSlm9 3�anc� SrSfer� I� V �ti :�' 1 Sc.0.te � "=40� = - � — , `./ i , / -�` �/ �� ----, ---, _ ��—�' — -- �=�, ' z 6 h . : !J � -- —. _,,. f _lL -�_,� �\ � ' � �--- � z'� 6d-� ' � ' ; �r„'.' r r .. �� ,, � �� St �'� � ! !., � ( I � � , . ;i ` i � 100� � � � : _ --� � o -Sr oK I �- �� >� �\` FK z"F.n '_ s�, U � I164n� ,- c�: `� �- f— �_I-�_�' 'j F. Connton pT '� � Q � ''�.�:.` . ST 9nJul�5 >�L��b �41 r �_fX.� � � � I --- - — . '. r � � (3r1: TopoF � L:d sP si . _ ' 36a. r r .. P�T.�K 3 i� ; = too.004F r n � _J � � _ T '- a l �[ � ! I � - - - � \1 , �� _ ` i Idb' �-; � ! ,y, �-1 z ` � y �� ` I �„�T __ ' I - �� : 2.� � _ -; `� .. I ! � � c o . �i �' = i 4 , ',;s,, � ` � _ I � : � Z . i � -: 1 J � � _ S � U ` = � � � � � '. '., � � 4"NC SewD o EMT r Dw� a � _ � mm�w�u I 6 I ` _ . �'�. y��EhT � , _ � l �; . _ ., ;---�__-�— ~ � . � . � ' - a I '. � = �-� ' f� _ � ; UN11 � ' � 1y I � � � � oNC ?•�._� - ; c � : � ( _ _ Bo�� la � :: '� , i � � � � � � v � � •. `:w ��\�75�� _ _ � Q 1 � — `� � _c.�'c'� ' � (�" y � � `-P'�t`°� / �' , . -1�-� r j � � � ^ � 1 � ,\ ,�.-� I V 1r i �. O `` M T r c� , r"_7 . � _�i I _ � t' yu�GaoL.YO =5 ' �- -' . �:� � Rarn rYq i . j j ' ��i�� \. / . � :�c^=sE i �__. . ,`\ - - - - -- \ / - � _. . � � ... _. . \ :�r, 2�i � � � 9.^ �` � ^^� :. . � � � �j c' �i` � � ;`r`�, . , ! �� i 1 �_ _ /'� ir . ��! ' . /" '' • ? � �'" �� \,/ � � i � , HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P N. 03/07), and the Sawyer County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 40.0 to 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90%of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Service Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons may be contacted: a. installer......................... Ronald A Spreckels Jr Phone: 715-558f472 b. Service Provider............... Scott's Septic Phone: 715-634-7279 c. Co. Zoning or Heaith Dept. Sawyer County Zoning & Conservation Phone: 715-634-8288 _ 11. _— Project: Isham - Dalens Resort- UNIT 2 Transaction Number: Page 4 014 . , HOLDING TANK SERVICING CONTRACT Contract Date: ag / � 5 / �Oa3 This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: C�eK•a � N ar+cy I s h a r►� S c.o � P�p p � Parcel Identification Number: (12 Digit Legacy ID) C� O 8 - � 1 3 - U U - d �' C� 4 1. The owner agrees to file a copy of this contract with the governmental unit, Sawyer County, which has accepted and recorded with the Office of the Register of Deeds, the Maintenance Agreement for a Holding Tank required under the Sawyer County Private Sewage System Ordinance for the issuance of a Sanitary Pernut for the installation of a holding tank(s). 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the servicing of the holding tank(s) as required under SPS 383.55, Wisconsin Administrative Code and the Sawyer County Private Sewage System Ordinance. The pumper further agrees to include the following in the report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The site address of the holding tank; d. The date the holding tank was serviced; e. The volumes in gallons of the contents pumped from the holding tank for each servicing; f. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with Sawyer County within ten (10) business days from the date of change to this service contract. Owner's Name: (Print) OWI18I''S SIg1lStlliO: (Only one owner signature required) �'�"' ` � S�''�'r` . �J�Y�---� Pumper's Name: (Print) Pumper's Signature: Sco tt Q6p �' � ,��:�,�� %�� Pumper's Registration Number: $ 18 � 3 Rev. 03/26/13 i ;�; � I � � I �IIII � II,lll��illll�lIll�l �� -USE BLACK INK ONLY- II IIIIII�I!I !11 !;il illll ill i I ! I I D�c�,:�t,j,,�.:;�; )SJ(yv_�,_ POWTS MAINTENANCE AGREEMENT Tx:��+r�;f For Holding Tanks ��5 DA9�03 Il `e-i�CC`D Owner's Name(s)as shown on deed: REGISTER�F QEEDS SAWYER CQ[lNTY, WI �j�Y'+G '� Nar1G1/ �Sha� lU%U�J%L►3L3 11:44 AM Parcel Identification Number: RECORDING FEE 30.00 (12 Digit Legacy ID) Qd $ - 01 � .3 - O U - U a. U O — -- --- Pl►G��: Z Legal Description of Property: -SEE ATTACHED SHEET - We acknowledge that application is being made for the installation of a holding tank(s)on the property described on the attached sheet. Return To:Sawyer County Zoning and Conservation Administration 10610 Main St.Suite 49,Hayward,WI 54843 As an inducement to the County of Sawyer to issue a sanitary permit for a holding tank on the above-described property,the owner is responsible for the operation and maintenance of the holding tank, locking device,alarm and access,and agrees to conform to all applicable requirements of SPS 383,Wis.Adm. Code relating to holding tank management, including the following: 1. The owner agrees to contract with a person who is licensed under Ch. NR 113,Wis.Adm.Code, except as provided by Section 281.48(3)(d), Stats.,to have the holding tank properly serviced and to file a copy of the service contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract,or a copy of a new service contract,with the governmental unit�nrithin ten(10)business days from the date of change to the service contract. 2. The owner agrees to contract with a person licensed under Ch. NR 113,Wis.Adm. Code,who shall submit pumping reports to the govemmental unit in accordance with SPS 383.55,Wis.Adm. Code,for the servicing of the holding tank. In the case of exemption under Section 281.48(3)(d), Stats.,the owner shall submit the report to the governmental unit. The govemmenta► unit may enter upon the property to investi�ate the condition of the holding tank when pumping reports may indicate the holding tank is not being properly maintained. 3. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in Section.254.59, Stats.,the governmental unit may enter upon the property and service, or cause the tank to be serviced. Pursuant to Section 145.20(4)Wis. Stats., a governmental unit may assess the owner of a private sewage system for costs related to the pumping of a septic or holding tank.The charges will be assessed as prescribed by Section 66.0703,stats. The owner agrees to pay all charges and cost incurred by the govemmental unit for inspection, pumping, hauling,or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. 4. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems � certifies that either a soil absorption system that complies with SPS 383,Wis.Adm. Code,or a municipal sewer serves the property. In addition,this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 5. This agreement shall be binding upon the owner,the heirs of the owner,and assignees of the owner.The owner shall submit the agreement to#he register of deeds,and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. -Only one owner si nature required- ACKNOWLEDGMENT Owner' i natu`� State of: v11 Sc��S;�1 — C�Unty�f. rS�i,.�ye r _ Owner's Name (Print): Subscribed and sworn to before me on this (i�n� ISharn �,,,,,,. WS,,�� - S�day of �v��,~`�< , 20 �3 . Date: r`��O,. • ..�y�'Qwner's Name): �I'� _ 09 / S l a �'� •' R yNntars�Public Signature: Y Drafted by: ' �:� .� �� Pu�ilic3�lotary Name (Print): ' �� Co Z��w'�: • z • — 1d �e.c.Kcl r' ��,��y=E9�mission expires on: (� _ ' �. "'-.,,sT�•�..... •••�So�,r ��'��.,qTE OF`�`��•��`• Personal information you provide may be used for secondary purposes�'tPriusay'�aw,§15.04(I)(m)] Rev.03/26/13 Dalen's Condo, Unit Two (2) 1014/23, 827 AM Real Property Listing Page Redl EState Sawyer County Property Listing Property Status: Current 7oday's Date: 10/4/2023 Created On: 2/6/2007 7:55:14 AM �Description Updated: 9/13/2011 '� Ownership Updated 2/6/2007 Tax ID: 7921 � GENE&NANCY ISHAM BIRCHWOOD WI PIN: 57-008-2-37-09-07-5 16-741-000200 Legacy PIN: 008213000200 Billing Address: Mailing Address: Map ID: -26.2 GENE&NANCY ISHAM GENE&NANCY ISHAM Municipality: (008)TOWN OF EDGEWATER ll64N COUNTY HWY F ll64N COUNN HWl'F STR: 507 T37N R09W BIRCHWOOD WI 54817 BIRCHWOOD WI 54817 Destription: DALEN'S CONDO DECL 332086 UNIT 2& m 1/il INT IN COMMON ELEMENTS r Site Address * indicates Private Road Recorded Acres: 0.215 N�q � Calculated Acres: 0.014 Lottery Claims: 0 J property Assessment Updated: 5/11/2023 First Dollar: Yes Waterbody: Chetac Lake 2023 Assessment Detail Zoning: (RRl) Residential/Recreational One �ode Acres Land Imp. ESN: 430 G2-COMMERCIAL 0.215 20,300 19,600 2-Year Comparison 2022 2023 Change �� Tax Districts Updated: 2/6/2007 Land: 100 20,300 20,200.0°/a 1 State of Wismnsin Improved: 0 19,600 100.0% 57 Sawyer County Total: 100 39,900 39,800.0°/a 008 Town of Edgewater 650441 Birchwood School Distrid 001700 Technical College ',+�property History N/A . Recorded Documentr Updated: 6/12/2023 WARRANTY DEED Date Recorded: 3/3/2003 308750 840/578 CONDO DECLARATION AMENDED Date Recorded: 5/26/2023 444 https:Utas.sawyercountygov.orglsystem/frames.asp?uname=Eric+Wellauer �� r� � G 2 - �. , �F a� � � � �_� � � .� �('�"� �3l•'. �f,��,f'a', � �� `''':� M y aM, � 5 M � . ..�4� ;� .• { �" � t� �PS g^r 'r " ��y,�f ,y * j � `� `r "''. "r u''�,i t�� ,,r�'�,4� '- - i � t�i. � r��'r +� 'R � ��. ��ti . �� r�� i� 5. �� .. - _�'•«r. , ., rr j �,� yr,�' t ti+-, ,� +r �`r �j;'a� � �4 s „r..z.'� .'f` .•�.y� . 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M- .'+...., w��i� - ;-� �''"`�; PRIVATE ONSITE WASTE TREATMENT County � � oS SYSTEMS Sawyer -�,� �s , ( POWTS) \k `-E! °' ""`' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �3 _2�5�- Personal infonnation you provide may be used for sccondary purposes[Privacy Law,s. 15.04(i)(m)] Permit Holder's Name: ❑City ❑ Village I�'Town of: State Plan Transaction ID#: lNt►�, �l"��l �S v�aw� �� d .�a Insp BM Elev: B Description: Parcei Tax No: / �6�•a `�� a� �tT �;sszr �i po$-�13-Go -,a�oa TANK INFORM TION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark � o� Dosing Aeration Bidg. Sewer qrj �-� Holding �,,,�e�— ��cs�p St/Ht Inlet �SQ � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding �l-ft�` ��` � +-�' L-,2�' 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 �N L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters � GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other - ---- — - -----__---_ _-- DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size I X Hole Observation Pipes �i Length Dia Length Dia Spac � Spacing ❑ Yes ❑ No � ---- — --- ------------ ---- SOIL COVER - —--- Depth Over Depth Over ' Depth of � Seeded I Sodded Mulched � Cell Center Cell Edges Topsoil ____ ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) -�``h�s�,((�( I o�r6 ��?� -� �t<7; Plan revision required?❑Yes ❑ No � �� ' �' ', � �3 .?2 �Y � ,_ ` �,, ; ��1(� L— - Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) ADOITIONAL COMMENTS AN� SKETCH SANITARY PERMIT NUMBEA: �3'_a6 S_ _ �`1 �� . � , : � ; ; __ _ _ _ - _�� _�-- - - _ - _ , , � ; u�;� ��s_ �� . 3 �, i � �..�" '�'�� ; ,�;ea� �� J T� �� -�-- - t 5 GAtf--�—