HomeMy WebLinkAbout008-213-00-0300-SAN-2023-266 Department of Safety c°°"�' �
-�� Sc.�w r' �-
: � = & Professional Services,
_ �, t - Sanitary Permit Numb r(to be filled in by(
�, �_ � Industry Services Division g�
`� Co S I l�5 l� �
vr
Sanitary Permit Application State Transaction Number �
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 permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ad.,�.,�,�
the Department of Safety and Protessional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. IS_04(1)(m),Stats.
1.Application Information—Please Print All Information CV v�+'4` ��W ��
Property Owner's Name Pazcel il
� � a�c �S�r1G M OC� $ - ��3-00 v3o 0
Property Owners Mailing Address Property Location
� 7(.`-! N Cou n� . I' GovL Lot
City,State 7ip Code Phone Number
%4, '/<, Section_�
13;�c1�waod, c.�2 5�+81^I
IL Type of Building(check all that apply) Lot# T 3�1 N R f� --Eor
�I or 2 Family Dwelling—Number ofBedrooms � u N I T .# _j Subdivision Name
Block# w LEN` n�d
❑Public/Commercial—Describe Use
❑City of __
❑State Owned—Describe Usc CSM Number ❑Village of
�I'own of�Ct�✓a�'t'� _------
t[1.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one 6ox on line B.Complete line C i
a licable.
1.
❑ New System �:Replacement System ❑ Other Modification to Existing System(explain) ❑Additional Pretreatrnent Unit(explain)
�' �Holding Tank ❑ In-Ground ❑At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C. ❑ Kenewal Before ❑ Revision ❑Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and Date Issued
F.xpiration �M�, �
IV.Dispersal/['reatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Reyuired(s� Dispersal Area Proposed(s� System Elevation
g-e�-�� /'�!/r� N/,� N 1 r� �v/A
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o � �
New Tanks Existing Tanks � o v ` Y � co c`�
a. U �n. �, � i�. C7 a.
Septic or Holding Tank �
U l7 U O 1 i
Dosing Chamber
V.Responsibility Statement- t,the undersigned,assume responsibility for iostallation of the POWTS shown on the attached plans.
Plumber�s Name(Yrint) Plumher's Signature MP/MPRS Number C3usiness Phone Numbe�
R�+alc� A S �,ecK,e �s T� � aa �GBS ��S- 5S$ -G47a
Plumber's Address(S eet,City,State,Zip Code)
9aosN 5+0.� R�d a� J-�� �..Ta�a, ws .s�By3
V1.Co nt /Department Use Only
�A�ip o ❑Disapproved Permit Fee Date[ssued Issuing Agent Signature
��'✓ ❑Owner(iiven Reason for Denial $ `��� l L'' � t� '�� �����'�^`
Conditions of Approval/Reasons for Disapproval � �����57 7 r�i
V
Q�IG[ I���. .�:� �-��j �,,
^,�����_,. OCT 0 4 2023
C�S � / 'b� , , ';�3 �7 _ SAWYER COUN7Y
ZONING ADMINISTRATIOPI
Attach ro complete plans for the system and subroit to the County only on paper not less than 8 1!2 x I I inc6es in size —��,� ��
NQ RCFUN��AFTER
ss�-es9s�x.o3i22� IS��J�QF f�RMiT
Sawyer County Zoning & Conservation Administration
```"`1' 10610 Main Street, Suite 49
� �R c� 1� Hayward,Wisconsin 54843
'�i' ��G I (715)634-8288
� � FAX(715)638-3277
� �/ ��.1�I
�PI �
�� _ —�� _ �I�j www.sawyercountygov.�i�
� E-mail:sanitarian(msawYercountygcry org
�I����=_��� , i��� Toll Free Courthouse/General Information 1-877-699-4ll0
^�rY `��
��j�`ON��
Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stainp � � /� y / �-J
Parcel ID# � o g - a-� 3 _o o _ 0 3 00
II. Plot Plan:
9( Property Lines x Benchmark BM ♦
X Site Address �North Arrow
�Structure x Scale
�Well <25' to Service Road
X Legal Description �'Nearest Road Intersection
X Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans:
�Index Page with Original Signature
�( Management Plan/Contingency Plan
x Servicing Contract
X Holding Tank Agreetnent Form ($30 to ROD)
IV. Holding Tank Specifications:
�Tank Cross-Section: Manufacturer: w��� Gallons: oao
�Tank Anchor Calculations [SPS 383.43 (8) (g)]
�Locking device, chains/locks
�Alann, electrical per SPS 383.43 (8) (e)
�3" Bedding Material < 1/2 "
V. POWTS Coinponent Manual Reference:
�Holding Tank Version 2.1 (May 2022-2027)
Owner: w� �h�T��) Plumber: �S��'•
Application Review Date: (a(� (�O 2�
POWTS Reviewer: ��;.�
N��nt
6`��(� Rev. 4/27/2023
Credential#
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Isham-Dalens Resort-UNIT 3
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#3
Parcel ID Number 008-213-00 0300
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 �.(���� Phone No. 7�5-558-6472
License Number 226688 Date 10/04/23
Designed pursuant to:
Holding Tank Component Manual For POWTS(Version�) M4y ao>>
SBD-10855-P(N.03/07)
Version 7D(03/12) Page 1 of 4
HOLDING TANK SPECIFICATIONS
�2 Number of bedrooms
Non-residential estimated flow(gpd)
��Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity (gai)
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 depth of soil cover(ft) 20505 Ibs Weight of anchor required
66.0 Height(in) Outside 27.3 in Soil cover req. for anchor or
151.0 Length (in) Dimensions 5.1 yd' Concrete counter weight
86.0 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished ��ent cap
junction � waming label grade
box � I �
4"min. y 72"min.
23 in.
Manhole and vent locations
conduit —� vent pipe
18"min.
� tetherweight - �
� � 12.0 Ifl. building sewer
service inlet
blind plug aiarm on Note: All tank joints, and
co seai joints between tank
outiet 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 negate buoyancy.
Project: Isham - Dalens Resort- UNIT 3
Transaction Number: Page 2 of 4
i� L oT I�� AN p�° � � 9
fln.lehS CaN��S ua+z p3 - On�Ens's aesoaT Cofis�60
Gene � TJahc� J--S�a �M1 SEt o7 , T37N , R09W
�76� ,U �.'o Nw,_,� � G To�.7N aF [D6Ct.anTER� SAW)'�RCOV+.�Ty
i3 ����wo�d� W l s481'7 P��• 0�8- a�3-ob o3 o O
-��_ 35y _ 3S�o
HT - �o00c�e.�.� .�eFqbConcir)c �-{o/d:n� T�y�7�
I�adc by W�tSc� Co»c�vltlnc .
o �e os yo sb ao
_ l�ExtSi� "�'wnK�S �v be prope�ly oio�nel�wdA and
i = d:Se�nEa}ed Crwn <�lSFm9 SHan�7 5�.5ler�
�' \
I --
F�� -� /��` '=�� I
� Sc0.�r f ��=40 , ' /� ^ —� —'�-� / ==/
_ � -- �� . � z-6 d _ � :., ` .. "� i
� �-��,� � f� r� - t � �
_ ` `__—.• ! z 6d. '—; ! ' �
� ' � �
�� � �n .. \ �� I _ � Sr E x . � �ov' � L--___J
� �' . . , __> . .
cC � �: _ '----I_' � d -s r o K l
�
o f f�b�llJ �! �—\ ' Fx z"Fn _fzas' � Pr �
v .c:: \ �- {� e. Conntoa
� ��. 1 sT JMJ�::�S ��!���5 �FI
� �-, � / _ex.l
� (3j�1= TopeF
f � --- — — � ' � ! �:a <P
BI . � abd- f I + P�,.pre..K
3 a � . _� � \ � loO.00�E r
_ � .- � �� � ! - - - ' � L 1
- ` reb• `--� ' 1 =' t-�
d � � •
Zz e - =� ��': 1`. � - � UU'�lT '— I � = �� v�
`c a � . - r � l ' `�:.., ��`-
� . I r — � N
` Q J , . z ( t � � � \�:�\,\ S
I ~ L----� u
_ f ',-
� - t T � c `•� �
` � - - � H"NCS���D ` OfMf'
oW; 6 � _ ASiMT�11 - I �.` i _ `\ �
y E rrs � ` �/
. � �— — ' a - � — '
�i . _ .+ , =
C:' s . � � N 1 ' L - ��: L I
� : � UNI\ I � I � ' ' _ < ' �1 (.�yJNG�
?�`.�� � : • � � � � _ �
=f`� i R f � � U � ' ��.
�;= - ` ,,5 � _ _ , ._
- ' Gry� N5� � ¢ � .5"`"d -�/
--r� . � ���y_ � � - �+Kt rvi'
i ' � - -`�-' C � `
r- i j
E ( � .'O
'\ �• � �JN 1 T � _ /
..�.: ^ . � {.µT : ._ �
��� ° ` i . �� �r ,.
. . _ ,'': j � F 4 MGSct,VO -
� `,� — Rbr»i9'11 '
• i ' ;c..;i . , J
� f •"*.PP.b° '�� /
. 1 . \ i ..s'. .
I ','.r_.. -' I . . � � ?'\ i ��.: : -. i��^^��
. � • ' � . �
� �� i
. . . - . /le'� ; ? � � i_ _ /`:-<<
�� t � �
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: 715-558-6472
b. Service Provider............... Scott's Septic Phone: 715-634-7279
c. Co. Zoning or Health Dept. Sawyer County Zoning & Conservation Phone: 715-634-8288
11.
Project: Isham - Dalens Resort- UNIT 3
Transaction Number: Page 4 014
HOLDING TANK SERVICING CONTRACT
Coatract Date: a9 /a S ! �Oa
This contract is made between the Holding Tank Owner and the Pumper.
Aolding Tank Owner's Name: Pumper's Name:
(oe�..e � Na,�,cy Istiarn Se.et-r PoPPe
Parcel Identification Number:
(12 Digit Legacy ID) O � 8 - a 1 3 -� U -d � U O
1. The owncr 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,thc Maintenance
Agreement for a Holding Tank required under the Sawyer County Private Sewage System
Ordinance for the issuance of a Sanitary Permit 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
pemut the pumper to have access aad 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
fiuther 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 agees 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 Admi�istrative
Code and the Sawyer County Privatc Sewage System Ordinance. The pumper fiuther
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;
£ 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 ttus service contract.
Owner'sName: (Print) OWIIEi'S S1gI13[111E: (Ontyoneownersigoatarerequired)
G�� Is►�• � �
Pumper's Name: (Print) Pumper's Signature:
Sco tt Q6p(� � ,5��./Y �
Pumper's Registration Number:
$ 18 �3
Rev.03/26/l3
�� ��iiiii � ii�� � �� ei �iii,i
- USE BLACK INK ONLY - �� I��I�Ilil��ll III� �Ilill � lil
DoC! :501�6oi
POWTS MAINTENANCE AGREEMENT Tx :4047�17
For Holding Tanks 4�G7s6
I p�!.�ie ru,�c��
Owner's Name(s) as shown on deed: REGISTEft OF DEEDS
SAWYER COUNTY, WI
GG�G '�" NCr�CY I S�'�!'^M lU%tl`J%LiIL.S l I:44 AM
Parcel Identification Number. RECORDING FE� 30.0[3
(12 Digit Legacy ID) �� � - � �3 - O O - 0 3 o a
— — PAGES: 2
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 properiy 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 govemmental unit within 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 governmental 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 governmental
unit may enter upon the property to investigate 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 the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which wi I
permit the existence of the agreement to be determined by reference to the property where the holding tank is installed.
- On1 one owner si nature required - ACKNOWLEDGMENT
Ow r's Sig t e: State of: '��✓ � S,r D n S� �'1 _
County of: ��, i,�l�� � _
Owner's Name (Print): Su ribed and sworn to before me on this
G �L tiarn `,`� N,,,,,,�_�day ot �;< l,�1' , 20 3 �
Date: ,`r�.��p2� WS,�-�y,�(Owner s Name): t',-�d� �.n �^ _
C 0 � — .�.3 •� -� .•'' �'�Notary Public Signature: -L- _
Drafted by: _ �.' �O� R Y Pi�bli� Notary Name (Print)_ �� I�C:. �f u w�,':
1Zar.a�d s -KCKt.15 T�' z � � GNFy�c�nmission expires on: ��.� _
: P�gL� � v� :
's,� '' ,.G��r;
. tA�;•.,.
,,,� �T ,� ,������� \5 ```,,
Personal information you provide may be used for secondary pw73b�s���v��a�Tw, § 15.04 (I) (m)] Rev. 03/26/13
Dalen's Condo, Unit Three (3)
10/4l23, 8:27 AM Real Property Listing Page
Real EState Sawyer County Property Listing Property status: Current
Today'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: 7922 GENE & NANCY ISHAM BIRCHWOOD WI
PIN: 57-008-2-37-09-07-5 16-741-000300
Legacy PIN: 008213000300 Billing Address: Mailing Address:
Map ID: -26.3 GENE & NANCY ISHAM GENE & NANCY ISHAM
Municipality: (008) TOWN OF EDGEWATER 1764N COUNTY HWY F 1764N COUNTY HWY F
STR: S07 T37N R09W BIRCHWOOD WI 54817 BIRCHWOOD WI 54817
Description: DALEN'S CONDO DECL 332088 UNIT 3 &
1/11 INT IN COMMON ELEMENTS � Site Address * indicates Private Road
Recorded Acres: 0.215 N/A
Calculated Acres: 0.014
Lottery Claims: 0 � Property Assessment Updated: 5/11/2023
First Dollar: Yes
Waterbody: Chetac Lake 2023 Assessment Detail
Zoning: (RRl) Residential/Recreational One Code Acres Land Imp.
ESN: 430 G2-COMMERCIAL 0.215 20,300 18,200
2-Year Comparison 2022 2023 Change
� Tax Districts Updated: 2/6/2007 Land: 100 20,300 20,200.0%
1 State of Wisconsin Improved: 0 18,200 100.0%
57 Sawyer County Total: 100 38,500 38,400.0%
008 Town of Edgewater
650441 Birchwood School District
001700 Technical College ;� property History
. N/A
+ Recorded Documents Updated: 6/12/2023
WARRANTY DEED
Date Recorded: 3/3/2003 308750 840/578
CONDO DECIARATION AMENDED
Date Recorded: 5/Z6/2023 444685
https://tas.sawyercountygov.orglsystem/frames.asp?uname=Eric+Wellauer 1/1
�
u
2
�7�,s�
� �
�� L
'� F y.
..����"' „�,�� ,�:¢p.'r,
�t��i. �.�. '`�,� �'�"�
�r'�, �-: .. � ',
_�i!h.�- 'M:� '+v '�#� �_ )'
X �� '
'� h ��'� r� mx
�;,'PA t ;n'� 4 z r'!��+��1�t� -1..
�yy . F �'„� _ -•�4.� � "' '�'4,. � , �� -
r � � ' � � r d/y+�
k,• ,. +- � �'•� °_� +A., �l 3�j' .
'� #
'r�r,m �s�, ,� ,, 5,,��� � �_n 't 1+�e.�^- � � .
«<:���������"7� " . J {� F��'�}``. �� �' �� ' ���`„�r���� ���-�}1` � +^.e.
, ' ` .a. � :i �y�.�� li���:�i'��y ' �:
N �, '� �. �1�a�k� r•.
�• ,a ,! �� 1,, . '^' �� ���4;''r#r �'� ` `'Y '"�,: i � r � .x
_ �, , r19�aTf �1 a,,
�}; 3 i.°'^4i+� t ;1 14:�qs'. y �`'`Y. 1 �k+ ���.
�� P��_{ • ��" wr .� ..yF��yr '�- f �`�,. _.�`..� �.:*�t�
'�` � .`�^4 .�• + ` A� ,���"Y'� �.S11t�`"'t.4..' � :.�� � J��� 4',��, J(/F� .Fi
r i�' 1�' ,n,J' �� '�j�r �f�y�Y . � �'� .l�' .
.�9 t }�. ¢ U X'� .1 _ ^ .�"` . � . �j �,U��P ,�. ' ' 'k { �.�,�"a+ . _ py'R< '`" �'°f
, '� "� ���� .,��Y � ^r�irs�' � � �' . , i 4 �.T a a1F" �;,��.'y
�-"� -. .7 � -'* f. � ' �� �-s . t r� *,.�.• �7�
�� 4�`a••'� � 1 •'.t ��• ' � _. - - �' �
� ���,� � �� � '
, �� �� ��+s'>.' 4 �# �t-♦ l� .� � _• 'i+,. ��
�R � a"-�• , . �I_� �' - . . �,�;�f�� ..,. � ' i $- r-
1���`�'� !r�j;�' '@�-, ;-_`_*�;,• Z ._��;in . . " ".#� - • + ti'' ,, � �,�
," �' ,..
� r. . R '. :+� '
; �;'� . . � + .� ' . ..� � �'�n.$� .. -s/ .��
, ' : r � . ' . ��• � �� ,� . r�--
{ ,�. ,3�-.. ��L ,� �T.r". 4,�� �, _� ,,.i t ���� .�L
. . . ��'da. �. . � ga:- C�;��i±+" '{.�� - . .:� J
v ;, i� ✓.�' - _ � f.'. �' � �� .^,� .. �k ��'
. S u - "a..-:.. ,: � ��� . :.
' � , � y�.� f� ;�� � `�.�,_�d ��'-q��TMr.� �` 'f � ,��
\..'- � �4.M''�-��',•�, . e�+ �� _�1 1�-' q ;:��y. �� A ta�� '. . . �'.. fr ' �.
.�' � . �� �� 1 �1 � ... .�. ��l�`� . 3 � �� ag�`����y��,.:,• '�s '� ti w,.
� i � . ..,�� � �
- _ � .. . �. _ y. � ��''� 5,� . i � �'� �. � �'4�;
4 . �F', �`:.��v'. � �� �,r i� ,��"__ f u-t. �
� ""'�.__-- 7/ � ' ;�t�• i � j �`- �
�. .��, ; ��
-"`_�-' x". - ,� z.�r � �1�. If� �; .
. j _ � , { . n _ � , �43
1 _s.� . � �� � i. . - 4. �� ',.y�,, e� �� I,` > _' r�,�+�,
�'A;,''�� r^ -� �'�--- - �,�+k .:� 1 �.��{,� . r} al :f � a. ��/� ��,`� �.�r.
.�+e��...,-- .Y^ - . . ,___-aw_ �,� �a�' � � `: 1 � �.
�'�~- Y� �'.M1 , }' ` � �-_ � � t ; - p�~1*„ 1 ' . . � ' � "
i y ,�
. e � +� �. . '.
. . a �
�� �'�: . ' '� �--```_`—-' � :�`� ��,`
� ,. .
;:�.� ��: ' ^► • ' .. - � . .. . Y'
"+ A, �+T� � jF .:`�'4i��.� y_�, _ _ ��'-�j;�"'^�"�1..�_ � �~� ,� � . ' � �� .,
"���. � � y� +�� . - ., �BF . L�'�•....:-.:_.,,,.:. . Y(�' . -d o ��+
-�.�x�y9"�. ts '1 V ."'��� :'�` �.��.i .'�'h.y . � .. 'S'��`�.� �,',i. -y.� �T:,
�
�
:,� �,a, r .:
+. 'S w-'+ri� ��-A,,,d�a» v+ � k *N �,�'C� '1t ++ `--�.._ � ,- '+�,, .
w- k
":� t1 k - y � . �� � '�.�
A�� �.g�V'1�J'{'u'T'��.,�� �y;�.�{ J r �., d} ,��,� ,�� �..'4�,�y, _ "�,+.�„ `M1`.._' 'F ,���I ,,.��£G
• . _ � `,-,--.
,��yb" � �' ��T�rt �. *t'�'��� a. �1 �a.. � � � �-- � �,`'�°o�
�r '�:* K �_ �'^+�� s,..r"�' �',';�'�'Y'r * �
�.x+`�'� �� .r� � ��:5 v �i.a����!�xk S.�'��� --,,,R s . x'"" '�1�e� e'°�:., `�- ..��.
�v 1� p�
'� •.�' � . . ` � ���t `#, ,�ro � }� : � . ,M ' � ..__'�'C��_
� { �. ' J �� '�f� „t •^ �S, � + �� _yY\-J�r '�".'�.�,'"�, ��Y�` � P E U�
. ��! '. _. ..5 T' r "1,,,�,�,s. � �wK-' �. �r, ��.x .�t� ea,g� � �a . , � �--
*' � u �t w4 � , 4+ �'�r'�'� 'M•--."-wl �`'� O �=m 3
s �.# �,��* �h'_ �.� ��� r:�-hr�4�-a�'� x ����� • ,'� - " 4�1"' C o �r y�.� in �=�� -
�; D r `x `� : si� .Y�B � a -� ; ,� y� i �� *"�„ ' �*`� y
���. :, � � _ r t � � � �� .. � ,+.ti� :-_., .. �tid' iis{���"'+�x. _�� .t.
�}� `_ �°�` �^�{'M��'� .�i,.:a�I� a ;,.� a';-�`' �iµ°.yy!w!'�_ 7"`�,�.-/ �..r"r; ` �;`�Ry�
,�,� - :'�r� ��,. �� ��.. "�•� ' 1�,..
'
. �
R�...^w_yn .� � , �.t�� M � �ya
., ,
�� ,�' ,y,...�"'� �'._#t ♦ � �i„+6.x.:�....t`�j '�H� 'ha«- r.r t�� � ..� �..'� ,,1'� : .o o �
�� �'t�. 'a�1���q y�1"`�a_a."'ks>� f��`E���. "'�4 1� t,,'�����4��� �.,� , � i
��. .' .�'�s�, ��.�� `Knc�,A.... �� tl,�# k �'�.�y r 1� i 'tl'^�'�� �`` re,i,•,
� '"'`E`�; PRIVATE ONSITE WASTE TREATMENT county
- ���5 ,�, SYSTEMS SaW er
.j�,,1 Ps , ( POWTS) Y
, R �.��-
`�'""� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION oZ3 — ��C�
Personal information you provide may be used for secondary puiposes[Privacy Law,s. 15.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village [�J Town of: State Plan Transaction ID#�
G.e�w. fi N�� ��a� L�'d�..,,rg�.e�- �-
Insp BM Elev: BM Description: r� Parcel Tax No:
�vV` �I fid b � ' 1� ��T' �l� \'"�� �'�.► a�3 �VGJ 'V�QV
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark �� b�
Dosing
Aeration Bldg. Sewer �Q���
Holding w�QS.sZJ— � St/Ht Inlet �Q �
TANK SETBACK INFORMATION St I Ht Outlet '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man.
Holding �{� �� $ .'s� L,�S Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Gratle
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 Bidg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
--- -- -- — - _-----_ _ _--- --- ----- ------ __--
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifoltl Distribution Pipe(s) �X Hole Size � X Hole Observation Pipes
Length Dia � Length Dia Spac ' ', Spacing ❑Yes ❑ No
- - -- - ------ --------
SOIL COVER
Depth Over Depth Over I Depth of Seeded I Sodded Mulched
Cell Center l Cell Edges �, Topsoil � ❑Yes ❑ No � �Yes ❑ U�
COMMENTS: (Include code discrepancies, persons present,etc.)
��,S R(� �a�f� ��3
� �.�
�
� � ,
Plan revision required?0 Yes ❑ No '� p`�1
�3�� �� '� ` � __, ��.�
Y �I ____ - -- -
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITI�NAL COMMENTS AND SKETCH
SANITAAY PEAMIT NUMBER:_ 2�"��i o�__
(
\ '���
�
te�G�
- - -� '� �
. � ��M
� -
� �
� �
�3 , 3� , ��
� o s �
��)w� `
��o HT3
�(�(1��,
4��ss r� .
.� �, c�� �-
SCALE i°=