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Home My WebLink About022-738-22-4201-SAN-2023-280 ��;��^��,%::�� Industry Services Division ��h' � � '.� = 4822 Madison Yards Way w � =P Madlson,V�'I 53705 Sanitary Permit Numbcr(to be fillccl in b}�( `� = P.O.Box 7]62 � ;�,_; ;�', Madison,WI 53707-7162 � s � („"7 li � Sanitary Permit Application State Tiansaction Numbcr i � [n accordance with tiPS 383.21(2),Wis.Adm Code,submission of this form to the appropriate governmental unit pn is required priur to obt�ining a sanitary permit.Note:Application fom�s for state-owned POWTS aze submitted to Project Address(if different tfian mo-�iting ad � the Depanment of Safety a��d Professional Secvices.Personal information you provide may be used fot secondary pucposes in accurdance with th�Privacy Law,s. 15.04(1)(m),Stats. L Application Information-Please"Print All'lnformation ,j 1 ,i(/ Sf'. W • U _.__ Property Owner's Name Parcel# � U J 0. � G i 6'j.� -- Property Owners ailing Address Property Loca�n �v_� v e ��'� City,State Zip Code Phone Number �(/1.✓ '/4,��'/<, Section �---_ Goms oc w ✓�Y��6 II.Type of Building(check all�tfiat.appl}�)� �� u�;� � T 3 N R G or ___ �1 or 2 I�amily Dwclling-Numbcr ofBedrooms Subdivision Name �. -- 131ock# �ublic/Commercial-Describe Usc_ �-- ❑Ciry of __, ___ �S[a[e Owned- Dcieribe Usc _ -- CSM Number illage of ___ � //� / �Town of--n a a1.�Qt1�--- -------- III.Type of POWTS Permit:�(ChecK�cither"New"or�"Replacement"aod ottiei^appkcable on line A:�Checkone�box�on line B.Complete line C if a licablc.) . : '.' - A' �Iew Svstem ❑Replacement System �Other Moditication w Existing System(explain) ❑Addirional Pcetreatment Unit(explain) B' ❑Holding'1'a�ilc �In-Ground ❑At-Grade �Mound Individual Site Desi�m Other Type(explain) (conventional) _ List Previous Permit Number and Date lssued C. �Rencwal Beforc �Rcvision ❑Change of Plumber �ransfer to New Owner � ,:��,��„ p IV.Dispersal/Treatment Area and Tank�Informations �� '< <„� ,�,�:. ,..F'� � �. ��` .� � � Design Pluw(�;pd) Design Soii Application Rate(gPcl'st) Dispersal Are:�Required(s� Dispersal AreaProposed(s� System Elevation 3bo _ y�9 .5�0 5 . ' — Capacity in Total #of Manufacturer Y Tank[nfonnatii�n Gallons Gallons Units p w U � � w U U � y �. v New Tanl:s Existing Tanks a� o �? � a� p � � a U cn h v� w C� P. Scptic r fiolding Tank �� ..� �'�� Q� � Dosing Chamber ' � � � V.�Responsibilily Statement- I,the undersigned,assu�ne respnnsibility ibr inst:�llation of the POWTS shown on the attached plans. �� - --- Plumber's Namc(Print) Plumber's S[gna[urc SP�1PRS Number Susiness Phone Number ��l; -jCt� �e ��,�. 7/.S-9�.�-.?.3�.�_ Plucnber's Address(Strect,City,State,Zip Code) ��1 J w L-� �/�ti�d w S VI.Co ntv/Department Use Only � � � � ''�°r � � Permit Fee Date Issued Isswng Agent S�gnature �A�tl � �� Q� J��, pp ive '2 ❑ Disapproved $(,� a� '� '�3 ��%��`� /i""""— ❑Owner Given Reason for Denial �0 0. l u u � Conditions of Approval/Reasons for Disapproval 3 �� y� �� ,� � �L(�� l1 ;,l �� ►�G� f�`�� '� � �;hk#��,��3 -- t� OCT 20 2Q23 - `�� r=>-.,,��.� ^�S I � __ �� ` �� _.._ � z N N,G DM NIOSTRATION Attach to complete plans for the system aod submit to the f'ounty onty on paper not less ihan S 1/2 i 11 inches in size ��(� t�0 R:FJIv��AF7ER ss�-639s�a.o3ia1 j ISS�JE OF F��i�VtlT . ��y>��<i�u; . Department of Safety and Professional Services ��.I ', Division of Industry Services n ,' Plumbing Product Review ' ! '�S � — 4822 Madison Yards Way ' �� n � P.O.Box 7162 �� ` Madison,Wisconsin 53707-7162 �n' l\ ��k,�� -_ �� Phone 6a8-266-2112 � ��'-`��"�'�� Web htt ds s.��vi v �/L_��_ Email dsps@wisconsin.gov Governor Tony Evers Dan Hereth,Secretary Designee TTY:Contad Through Relay May 31, 2022 Dept.of Safety and Professional Services Bureau of Technical Services Division of Industry Services Brad lohnson Section Chief 4822 Madison Yards Way Madison WI 53705 Re: Description: POWTS Component Manual Manufacturer: Dept.of Safety and Professional Services Product Name: In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems Version 2.1(May 2022-2027) Model Number�s): v. 2.1 eSLA PTO No.: PP-051700077-PTOVPCR The specifications and/or plans for this plumbing product have been reviewed and determined to comply with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin StaYutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2027. This approval is contingent upon compliance with the following stipulation(s): 1. A copy of this approval letter shall be submitted with all plans using the In-Ground Soil Absorption Component Manual for Private Onsite WastewaterTreatment Systems Version 2.1(May 2Q22-2027). Pfans submitted without a copy of this approval letter may be denied. 2. This approval recognizes that POWTS systems designed,installed and maintained in accordance with this manual will provide treatment and dispersal of domestic wastewater that is acceptable in the context of ch.383 Wis.Adm.Code. 3. Systems installed in accordance with this POWTS Component Manual shall use leaching chambers that conform to ch. 384 Wis.Adm. Code. 4. Systems installed in accordance with this POWTS Component Manual shall be installed, maintained and used in strict accordance with the manufacturer's published instructions,Chapters 381-386 Wis.Adm.Code and this product approval. If there is a conflict between the manufacturer's instructions and the Wis.Adm.Code or this Plumbing Product Approval,then the Wis.Adm.Code and this Plumbing Product Approval shall take precedence. 5. Complete operation and maintenance instructions POWTS systems designed in accordance with this manual shall be provided to each system owner and remain onsite. 6. Systems designed in accordance with this manual shall be installed by persons holding the proper license or registration in accordance with Wis.Stats.§ 145. 7. Drain,waste and vent piping used to install these systems shall conform to s.SPS 384.30(1),(2)and(3)Wis.Adm. Code. Dept.of Safety and Professional Services May 31,2022 Page 2 of 2 eSLA PTO No.:PP-051700077-PTOVPCR 8. Cleanouts shall be installed in drain piping associated with the installation of these systems in accordance with s.SPS 382.35 Wis.Adm.Code. 9. Commercial food processing,food production,food servite,restaurants,taverns and similar establishments which may generate greases,fats,oils or similar substances;shall have state-approved grease interceptors installed upstream of POWTS systems designed in accordance with this manual in accordance with s.SPS 38234 Wis.Adm. Code. 10. DSPS POWTS plan approval shall be obtained from the department's Private Sewage Section,or the appropriate agent county,for: a. each installa[ion of POWTS systems designed in accordance with this manual;and b. high-strength and/or commercial POWTS systems designed in accordance with this manual. 11. A sanRary permit shall be obtained,in accordance with s.So5 383.21 Wis.Adm.Code,from the county,or other local authority havingjurisdiction,for each proposed installation of systems designed in accordance with this manual. 12. A complete and acceptable soil evaluation report,conforming to s.SPS 385.40 Wis.Adm.Code,shall be performed for all proposed systems designed in accordance with this manual. Technical notations: a. This approval supersedes the approval issued May 9,2017 under product file no.20170147. The department is in no way endorsing this component manual or any advertising and is not responsible for any situation which may resuft from its use. Sincerely, Brad lohnson—Sec[ion Chief Department of Safety and Professional Services Bureau of Technical Services Division of industry Services Phone: 920 492-5605 Email:BradlevJohnson@Wisconsin.�ov Ruby&.lar Ritchie Property Owners Name 3392N St. Hwy. 40 Property Address 22738224201 Tax Parcei Number Sawyer County Prt. NW-SE Legal Description 22 Section 38N Town 7W Range Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross-Section 5 Tank Information 6 Maintenance Plan 7 Contingency Plan Bruce Vitcenda Plumber's Name Plumber's Signature M.P. 220498 Plumber's License Number 715-943-2382 Plumber's Phone Number 10/11/22 Date 1r��' �O�af ✓Gf r N � l Page 1 of 7 n- roun oi sorpt�on - Version 2.1 Component Manual Used 2 Number of Bedrooms 0 Percent Siope (%) 94 Depth to Soil Limiting Factor(in.) 0.7 In Situ soil application rate 200 Estimated Wastewater Flow (gpd) 300 Design Wastewater Flow (gpd) 1 Number of System Elevations 92.8 Proposed System Elevation#1 - Proposed System Elevation #2 - Proposed System Elevation #3 96 Original Grade#1 96 Finished Grade#1 - Original Grade#2 - Finished Grade#2 - Original Grade#3 - Finished Grade#3 Skaw 800 Septic Tank Orenco 8" Biotube Effluent Filter BioDiffuser ARC 36 Chamber Type 13 Height of Chamber(in.) 25 sq.ft. per chamber{ESIA) 4.5 sq.ft. per pair of end caps (EISA) 5 laying length of chamber(ft.) 1.17 length of endcap(ft.) 33.75 Chamber width(in.) 2 Rows of Chambers 3 Distance Between Cells (ft.) 9 Number of chambers in first row 9 Number of chambers in second row 0 Number of chambers in third row 18 Proposed Number of Chambers Used 428.6 Minimum Distribution Cell Area Required (sq.ft.) 459 Distribution Cell Area Proposed (sq.ft.) Page 2 of 7 o w,uc� �l✓�ic/ AviYA Jar R;fcd;e gqvte v;frr✓dQ 3�7 zdo ra avr l4 . c",�rtocA�Ws.JYfA� �Reltiud,r�rWr48 �,.� �s 38.t M.O..Lk`M! /o ��- `R N(o��. �� a 3 M 4 x � rrui.a — — — , Sca I , QroP��i I � a I I � I Bi � ,�� 26Ar fYSf �: I - aes,i. � a � pA A + g� � /ri uw-lf I � 5.11 �3yw : i A 7w o � g3 VeutS Ja�[u°aA17jBAZy;e1 nf�i- _ — _ _ '_� 1ovNR�A;Sfe.� 4n•o.o�r.e.e� 90 t to,�s;d;�f �1-9f.y� �!�9L.e� 3�-9 f.7' Jkau poo N�s.�f�/cA�;o-�aY �a', ��Frt;nef;itr! S�o�tle�ei y�� q id11✓ ( I Scua ��:yp� � "a,t- Cress Section of a Two Cell In Ground Ccmpone��: Using Leachinq Chambers oDs/ervatlo^/ve�t Plpes / � 96.00 Finished Grade - __.___ __-_ Finished GJade _Ir— Sbpe 0% / CeUS`eperatbn � � , � 3 t � � i �._._ , � . ` ; �,,'�� J � � 96.00 Original Grade ?;�� ;�' , ' ?;� bfginal Grade 93.88 Top of Chamber ��=�` � .' %Top of Chamber 93.88 �- , , , ------ , � j . i l' , � "'" 92.80 System Elevation__ :. , , .� System Elevation� 92.80 • .Yreatn;e�t�pnd'D1ype�sal.Zope. ' . � , . ' ' : � . . , ' • . . . . . � _. .�� '' . . • .. - " '—' - ' ... . . ._.—_.�,_ � Limitinc; Factor Obse•va:b^�/Veti: pipes to be constucted ond copped w'9r opproved materiois fer (he partkWcr use. Dia rams Not To Scale 47.34 feet ' _�� O �� u� saw ; o , a�l rtf 1� arm .m+.' s� ' ,..� � .-- +Nr��.��'��Ie�w._ rne.�r�'��x.... � � � 1j .__._J �I � 1 ------ �, � 3 feet between cells — __j 1 k � � �-.� � .. . . ��ess�r•�.��rtAA► t�'s��; w�+++ 1:<nkr. �,� `. -.R,;Y4]�A,+�ww8a��.�3� 1RkU.'��a. {�.nGw. •.. _ 47.34 feel Observation/Vent Pipes to be located at the ends of the distribution celis. Page 4 of 7 WARNING: DEATH MAY OCCUR IF TANK . IS ENTERED WITHOUT PROPER � sKnw eoo � EQUIPMENT i O I I I 1 I 0 I I I I 1 I I I I I I I I I � 61.00" � TOP VIEW OF MANHOLE COVER � � i i i i � i I I I 1 I I I I 3.00 � � I ____��___�_��_J a.00��._rs.—_7 ��.-7 �---------------- � � OUTLET END VIEW OF TANK 2�.0o z�.00 � i _=24.00 � 24.00 5.00 ❑ I � � � �1.00 16.00 1 � 0 INLET 4 O � � 9.00 OUTLET 4' PRESS SEAL � 4' PfiESS SEAL CASKET OA9fETN5TALlED _ ____ _____________________ _ _________________ �cN Paur�o 18.00 2.00 I L BAFFLE FILTER 40.00 � �3.00 SECTION VIEW OF TANK & COVER PAGE; 1 OF 2 MODEL NUMBER: B00 s�A 1 tl p R E - C A S T PHONE: (715) 987-2277 APPROVED FOR: 5EPTIC, SIPHON, HOLDING, OR PUMP TOLL FREE: 1-800-924-8625 28255 105th STREET, NEW AUBURN HOME PHONE: (715) 987-2305 WEIGHT INLET DIM. OUTLET DIM. L1Q. ll�YTH GAL. / IN. MAX. CAP. WISCONSIN 54757 FAX: (715) 967-2707 (SHOP) FAX: (715) 987-2708 (HOME) 7,930 LBS. 45" 43'� 40" 20.12 805 GAL. Rub&Jar Ritchie 3392N St.H .40 2.27E+10 Number of Bedrooms 2 Septic Tank Skaw 800 Estimated Flow(average)gallons�day 200 Effiuent Filter Orenco 8"Biotube D@S19f1 FIOW(peak),(Estimated x 1.5)gal/day 3�� Soil A lication Rate al/da/fl� 0.7 Influent/Effluent Quali Monthl Average PRINT PAGE Fats,Oil&Grease(FOG) 30 mg/L Biochemical Ox en Demand(BODs� 220 mg/L Total Suspended Solids(TSSj 150 mg/L !!NOTE!! Servicing frequency of 12 months or less requires the Management Plan be recorded vnth ihe Register of Deeds. Maintenance Schedule Service Event Service Frequency Inspect condition of tank(s) At least once every 3 Year(s) Pum 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(s) Clean effluent filter At least once every 3 Year(s) 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 visual inspection of the tank(s)to identify any missing or broken hardware,identify 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 surtace. The ponding of effluent on the ground surtace may indicate a fai�ing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals 1/3 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 Sawyer County Zoning Dept within 30 days of any service event. Start-Up and Operation For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicais 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 infiltrative surface. Page 6 of i I Do not drive or park vehicles over tanks and dispersal cells. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the Irfe 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 permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with Wisconsin Administrative Code SPS 383.33; -All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. -The contents of alt tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. -After pumping, all tanks and pits shall be excavated and removed or their covers removed and the voidspace filled with soil, gravel or another inert solid material. Continqencv 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 identrfy a suitable replacement area. Upon failure of the POWTS a soil and site evaluation shall be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed to replace the failed POWTS. �A suitable replacement area has been evaluated and may be utilized for the Iceation of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should no be infringed upon by required setbacks from existing and proposed structures, lot lines and wells. Faiture to protect the replacements area will resutt 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 installed to repiace the failed POWTS. ��WARNING!! Septic, pump and other treatment tanks may contain lethal gasses and/or insufficient oxygen. Do not enter a septic, pump or other treatment tank under any circumstances. Death may resutt. Rescue of a person from the interior of a tank may be di�cult or impossible. POWTS Installer Septic Pumper Name Bruce Vitcenda Name Northwest Sanitary Phone# 715-943-2382 Phone# 715-943-2650 POWTS Maintainer Local Regulatory Authority Name Northwest Sanitary Agency Sawyer County Zoning Phone# 715-943-2650 Phone# 715-634-8288 7of7 Sa�l P �o�il � S� e�t Jwncr:�*��-4^i;�!f�� Sai i Tester: U , �i4 l� l/. > ../�� Spstern E-�e�r�zivn: y •8� ` Load Raie: � 7 System Range: �c 96 ---._-�:. — �},7 � 5� o ' � .... - � L/1 . .�.. sc • 6//o � T - 9 � ' . .. • ; 9S' �,,..'^--- 9S,3 ' _ ! .sr'� •6/9 ...... s� '6//b _ s. � ,�f,g _�____-- 9S�'� ' _ -- 9y.6 ' qy,6 � I _ .f,� , 6�d' 9 . .. .... S, c � c/ . 6/� ..... _ ... . ..� R3, 7 ' _ .... _ 9`l 2 . .. 93 .... � '"s , �/�d __-�--'�1 , �/✓.� .. . ... mJ . � �,` . _ _..... 9� _ . . . _ �..... . . .... _ ... � - _ . _.. . 3'9/•� , ....._ _, q� _ ..:: � �_-�— � - -- � _. . • _ ... -- .. }... , � �... ,. o ..... - .;.. . . �.._ .. 3.� ' _ ._ _.,... 3 , --__l___— � j � _�..._. _ ...... _ _�.. .. b 9 ------�-----. n,J�7�l, 6 .. ...... fiJ 7�r __ ml > > ----�-__.._ /! 6 � _ � .. _ _; _ �� _.. _}..,. . _ �. �'8'.0' --- _ by ',� � _ ! ... ��, Z , _. i.. - ... � _ � _. .... � . �,� ___�_^ ..... _.._ :.. ---�}---- .... �.._ ' i _ . � , _,. ... ;... , __---1-_.__ ' - .._�...... _ �..._ . _. . —�-^ --�-_, � _�...._ , . - _ ..... � ... _�.... . _ .� _ _ ....- ---�--�. ` + }.. _.,. . --�---1--- -----,� _. . �. .... _ � - .....�. .. . _1�...� _.i _.. . -----�---_ � i _... . � , , _�_� _ _ i ' .I, _ . —a--�.. , , ---=--� �.1,_._.. -----L--_-- '.c�'1' c"4:. Real�Estate Sawyer County Property Listing Progrerty Status: Cnrren� � Today's Date: $/24/2Q23 Created Qn: 2/6/2Q07 ?:�5:3� A1V1 �r�y' Description Updated: 4/2�!/2020 _-�. Ownership Updated: 5/15/2014 _ ._..._, ..... __ .._ _.. . _. __ . ._ .�..____. . __.... .. : _._ _ Talc ID: 22692 RUBY K RITCHIE COMS�T�OCK WI PIN: 57-022-2-38-07-22-4 02-000- JAY RITCHIE COMSTOCK WI 000010 Legacy PIN: 02273$224201 Billing Address: Mailing Address: Map ID: .14.1 RUBY K & JAY RUBY K & JAY Municipality: (022)TOWN OF RADISSON RITCHIE PI'�'CHIE STR: 522 T38N R07W 323 220TH AVE 323 22U'�H AVE Description: PRT NWSE COMSTQCK WI 54€326 �f��(ST�CK WI ��26 Recorded Acres: 13.260 Lottery Claims: 0 _x. Site Address * indicates Private Raad First Dol.lar: Yes 3�92�1 �'I'�1TE �-IWY 40 �.A�ISS(1?� �,4867 Zoning: (A-1)Agricultitr�l �ne ESN: ,� Property Asscss�e�t Updatetl: 4,�Q/��1� 20�3 Assessn��a��D�taiI ��.:'I`ax Districts Updated: 2/6/2007 Code Acre§ Land Iinp. _ _ _ _ 1 State af�Visconsin G1-I�ESIDENTIAL 1.000 �,(�(�Q :33,U00 57 Sawyer Counry G6-PRODU��'I�E 022 Town af Radisson FORFST i2•260 25,5Q� 0 576615 �nter Schoc�{ District 001700 Technical College 2-Year Comparison 2022 2023 Change Land: 30,500 30,500 0.0% �� Recorded Documents Updated: 1/17/2011 Improved: 23,000 23,000 0.0% FM. QUIT CLAIM DEED Total: 53,500 53,500 0.0�% Date 390360 Recorded: 5/13/2014 ��; MAP OF SURVEY = Property History ._ _ Date N�'� Recorc�eci: 4l24l�(l09 22387-Z1 :,�� 11��'OF SIIRVEY Date 22387-18 Recarded: J125/2008 ,�: QUIT CLAIM DEED Date 32703� Reeorded: 121212(}04 �:� C O`�ENANTS Date 311455 852/661 Recorded: 5/2312003 ,�,, � ,�"T"��`,� pRIVATE ONSITE WASTE TREATMENT county �"��S SYSTEMS Sawyer ,:_., `�s ( POWTS) � � '�`=� �� INSPECTION REPORT sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �.� -- �� Personal infonnation you provide may be used for secondary purposes[Pnvacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#: �.� �-5a �(' ��(n/ A�j _ Il l�\Q� ['��l'\ ��Sbli1 Insp BM Elev: BM Description: Parcel Tax No: l�b •� � ��-{�,,, d� s��` o�-�- ��3�d - ��-`�.2c I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic p'c� Benchmark �,d i Dosing Aeration Bldg. Sewer �}�'` 3� Holding St/Ht Inlet SS�c�y TANK SETBACK INFORMATION St/Ht Outlet � ,Q,s-' TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIR INTAKE Septic �j'D� �..35� I�p �--�p� NA Dt Bottom Oosing NA Installation Contour Aeration NA Header/Man. `�t 3.g Holding Dist.Pipe PUMP 151PHON INFORMATION Infiltrative i Surface 7:2.� Manufacturer Demand Final Grade Modei Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFOR TION DIMENSIONS `N 3 � S' �'S' #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate ` P I L Bldg Well o� IGP Chamber Model Number: INFORMATION Waters � AG o EZFIow CELL TO �-�D 3 � N ❑ Mound � Other �L3� --- -- -— ___- -- — __ _ __----- ---- -- DISTRIBUTION SYSTEM X Pressure Systems Only - - _ _ __ _-- Header I Manifoltl Distnbution Pipe(s) �Hole Size X Hole Observation Pipes _ Length Dia Length Dia Spac Spacing ❑Yes ❑ No � _ -- -- — — SOIL COVER — --- _- ----- -_- _ __ _ Depth Over Depth Over Depth of Seeded/Sodded Mulched � Cell Center Cell Edges Topsoil _ __ � p Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ��s�� /� �� -3 � �- Plan revision required?❑Yes ❑ No I I � I ,O3 ',��J II__��-- _ _- — G��l� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AODITIONAL COMMENTS Q� S�� SANITARY PEAMIT NUMBEA: oL _ � , y t �3s � � : . ! __ . _ . b � $ I� � �� 1 K�, ��' ;�,�. 2�� . _ l °' �— 3 i ---� x �1, � �I L �� • �.�k ( I �1 �,{ Ck� I 3�� `� y � �3 � �b �e�G ��- �