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Home My WebLink About004-738-18-1408-SAN-2023-311 �vtc"xrNe:ti��, County � > ° `� Industry Services Division sawyer K, �_ � 0 �� 1400 E Washington Ave �W $ � �� Sanitary Permit Number(to be filled in b� �, �� P.O. Box 7162 � yJ � ; Madison, WI 53707-7162 + '�� .>� (y-5� � �� w ��,,�„�,�- . Sanitary Permit Application State Transaction Numbe!' -� In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit • is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Addsess(if different than mailing address) u oses in accordance with the Privac Law,s. 15.04 I m,Stats. 1. A lication Information-Please Print All Information 5��' Property Owner's Name Parcel# Lazy River Retreat 4738181408 C��Y"�38�i8��Y�g Property Owner's Mailing Address PropeRy Location 11701 W State Hwy 27/70 Govt.Lot City,State Zip Code Phone Number SE'/<,NE'/4, Section 18 Couderay,WI 54828 --� (cirde one) T38N; R07EorW/ IL Type of Building(check all that apply) Lot# L� � 1 or 2 Family Dwelling-Number of Bedrooms Z Subdivision Name ❑Public/Commercial-Describe Use Block# �— ❑ City of ❑ State Owned-Describe Use CSM Number ❑ Village of CSM 38/22#8661 � Town of Couderay III.T e of Permit: Check onl one box on line A. Com lete line B if a licable A►. ❑ New System � Replacement System ❑ TreatmendHolding"I'ank Replacement Only ❑ Other Modification to Existing System(explainj B ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner uN�/ 7 ��"�+b�� n IV. T e of POWTS S stem/Com onent/Device: Check all that a I $S=t43 � Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Dispersal Area Required(s� Dispersal Arca Proposed(s� System Elevation 750 Rate(gpds� ]071.4 1]00 92.2',92.3',92.4' .7 VI.Tank Info Capaciry in � Gallons Total #of s � ° � •`-' Manufacturer .ro � v � �, ;, � � Gallons Units ` o �? � �, � � New Tanks Existing Tanks y U � �, �; �, � p„ Septic or Holding Tank ]000 1000 2000 2 Skaw Pre Cast � ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII.Responsibility Statement- 1,the undersigned,assume responsibility or installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Sign MP/MPRS Number Business Phone Number Thomas Gustum 227618 715-658-1344 Plumber's Address(Street,City,State,Zip Code) N13450 937'h Street New Auburn WI 54757 VIII.C u /De artment Use Onl �Ap�� ❑ Disapproved Permit Fee Date Issued [ssuiwn�Ageny��e , ❑ OwnerGiven Reason for Denial $ -l(,� `ro �� I��l I�?� ��r � � , ;'(�,. i C�- IX.Conditions of Approval/Reasons for Disapproval • L �3 � �;� � ��,� 3 � �� ' _ - �� _ .�.�.�.._ . � ,� , r , � � �._l- e_J � "1 � � � � � � �� :-:': +X'�'l.rj.� . . �, �� --1� �� . , ^/ f f/1 //� � �■ W Id V7� Ii Sr w._li,'�� •• C. '—{A�t NOV L ! iOL� j .� �� b'L� 1 ��i � � Attach to complete ns for the system and submit to the County only on paper not less than 8 1/2 x 11 inches i C;�i � �-5� 2 — .�1_l {�p zo��r�`��,�?��is;��-r�or� � \ 2 J {:.i rcZ�1 ;.�Sn'Ytla�.7�4�'rL.1l SBD-6398(R03/14).., E.'-��Rl�GF F�R;hfT�`��a�� . ►�fs�1�3 Chambers Page 1 of 5 Cover Page Project Name: Lazy River Retreat 750 GPD Conventional Owner's Name Lazy River Retreat LLC Owners Address 11701 W State HWY 27170 Couderay, WI 54828 Legal Description ; SE �; '/4, j NE �_'/ Sec 18 T 38 N, Rni W �; Township Couderay COUflty Sawyer >�i Subdivision CSM 38/22#8661 Lot# 2 ParcellD# 4738181408 Table of Contents P9� 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Management and Contingency Plan 5 Plot Plan total #of pages: 5 Designer Name: Thomas Gustum License#: 227618 Date: 11/13/2023 Ph. #: 715-658-1344 Signature: Design Methods Used "IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR POWTS" Version 2.1(May 2022-2027) Chambers Page 2 of 5 Calculations and Drawings Site Conditions Infiltration Elevations Site Type: Pr��te _•; Cell#1 Cell#2 Cell#3 %Slope 1.5 % Contour Elev: 95.20 95.30 95.40 Ft #of Bedrooms 5 Infiltration Elev: 92.20 92.30 92.40 Ft Depth to limiting factor 85 in Limiting Factor Elev: 88.12 88.22 88.32 Soil Application Rate: 0.7 gal/ft^2/day Treatment and Dispersal Zone: 4.08 4.08 4.08 Effluent Quality Eff#� ♦ Cover Material Required: 0 0 0 In Design Flow: 750 gal/day Finished Grade Over Cell: 95.20 95.30 95.40 Max BOD 220 mg/I Max TSS 150 mg/I Distribution Cell Septic Tank Choose chamber type:� �'; Septic Tank Manufacturer. Existing/ Skaw Pre Cast #of Cells�3 Septic Volume Chosen: 1000/ 1000 Laying Length: 10.00 Ft Effluent Filter Selected: Biotube FT0822-14-B FSO EISA Determined Area: 50.0 Ft2 Note Access opening of suffcient size to be provided to allow removal of filter Opening Open Bottom Area: 35.30 Ft2 to terminate at or above grade. Chamber Height: 12 Inches Required Infiltrative Area: 1071.4 Ft2 Actual Infiltration Area 1100 Ft2 Total#of Chambers: 22 Total Cell Length: 220.0 Ft Cross Section of Septic Tank Cross Section of Cell Vent in manhole cover o 4" Min. \� 12" Min. � � �� P --r n- �� i A� � " //��\ � //�A //��\ i � � �� Flawqia�nd ��JOII1tS t0 � `be water tight Plan View � �Effluent Filter ' �� - _ u J > � � J � � � . - - - ' n < � < - - � der Tank v � - : . - - � < /� � � < n - � _ � � �� G , � � POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_3_of_5_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner Lazy River Retreat TankManufacturer: Skaw pre—cast ❑ NA Permit# X Septic ❑ Dose ❑ Holding Volume: 1000 (gal) DESIGNPARAMETERS TankManufacturer: Skaw pre—cast X NA Number of Bedrooms: 5 ❑ NA ❑ Septic x Dose ❑ Holding Volume: (gal) Number of Public Facility Units: X NA Vertical Distance Tank Bottom(s)to Service Pad: (ft) Estimated (average) F►ow: 5 0 0 (gal/day) Horizontal Distance Tank(s)to Service Pad: (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design (peak) Flow= (estimated x 1.5): 7 5� (gal/day) if horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: 0 . 7 (gal/day/ft2) Effluent Filter Manufacturer: Biotube ❑ NA Standard (Domestic) InfluenUEffluent Monthly average Effluent Filter Model: FT0822-14-B FSO Fats,Oil&Grease (FOG) <_30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BODS) <220 mg/L ❑ NA ❑ NA Total Suspended Solids(TSS) <_150 m /L Pump Model: High Strength InfluenUEffluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BODS) >220 mg/L X NA X NA (TSS) >150 m /L ❑Mechanical Aeration ❑ Peat Filter Pretreated Effluent Monthl avera e ❑ Disinfection ❑Wetland Y 9 ❑ Sand/Gravel Filter ❑Other: (BODS) <_30 mg/L Soil Absorption System (TSS) <30 mg/L X NA Fecal Coliform( eometric mean) <_10^ x In-Ground(gravity) ❑ In-Ground(pressure) � NA Maximum Effluent Particle Size l�in dia. ❑ NA ❑At-Grade ❑ Mound ❑ Drip-Line ❑Other: Other: � NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) ❑ �en combined sludge and scum equals one-third (3�)of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: 3 years ❑month(s) (Maximum 3 years) ❑ NA X year(s) Inspect dispersal cell(s) At least once every: 3 years �month(s) (Maximum 3 years) ❑ NA X year(s) Clean effluent filter At least once eve 1 ear ❑ month(s) ❑ NA ry� y X year(s) Inspect pump, pump controls&alarm At least once every: ❑ month(s) ❑ NA ❑year(s) Fiush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑year(s) Other: At least once every: ❑ month(s) ❑ NA ❑year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (purnper). Tank inspections 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 a check for any back up or ponding of efFluent on the ground surface. Tfie soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (Y�) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of<_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) Page_4_of_5_ STf,RT UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator(pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications,oils, painting products, pesticides, sanitary napkins, solvents,tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator(pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. x The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perFormed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER Name Tom Gustum Name Tom Gustum Phone 715-658-1344 Phone 715-658-1344 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name Sawyer County Zoning Phone Phone 715-6 3 4-8 2 8 8 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(�and 83.54(1), (2)&(3),Wisconsin Administrative Code. 8 7 6 5 4 3 2 1 I Plot Map ' w • w � P/L . D w I S/o I Pe 1.5/ � w ' B1 ; � 94.95' � � � � � � � � � ; � � , � � , � � , � � � w ; � / , r i � i i i � i Total of 22 EZ ; % I Flow Chambers � % %B3 P/L C � � .,' 95.6' C , � ' � � � w � ; ' ; � I w � � � � � �a� , , 1 , � , , ; Q�� , � � , , � , � , , ' � , ASTM D3034 or ; � � -� , � � h4 4"PV i , � �, � � B2 �: � 94.95; / ; ' � 0 1000 Gal.Tank gM1 Driveway � � % � , , � � , � � ' S � � / B � , B �� existing P/L w n G, � Se tic � o m 5 Bdrm o � o House w � o � c � o � •Well w ' � �� w w Couderay River LEGEND q �J % =Soil Borings With Backhoe Gustum Lazy River Retreat p� (715) �' � BM1=ELEV. 100.0' -Bottom of siding on house-also HRP Septic �1701W State Hwy 27/70 Couderay,WI 54828 ^ Town of Couderay `J`J SCALE : 1�� — `to� I I SEYa of NEYa of Sec 18 T38N R07W — aE� _.. .,�� i �F.��.o orv�.o �.E�,t40, EE.1 f 1 8 "`w'`� 7 6 5 4 3 2 1 ( �a Legend Surface Water Data Viewer Map " I I t 2D Water Surface Elevation •� , Grid ..... ..:.- ..��...._ :�.lfilw��(i�i('n�Y"`Yf::- :,� � ) � , -�L.,��., _ - . r,1 _.,- ��1. . .:".. ?.��f•. .��if'.`[��.g..�..��.. i� 4 � . 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' � ��Ay. : :�;r, i,• '�%rt :T�� a�� . � �� . ' '� Structure not on Waterway � �,,.✓"� r� �c _« �} �y, ��,� �` � ' .�r� i � � � <all other values> � � � �4'r `.'%-�Y',' :`-y��, » .�' �1.� : -� -Ai • � ;� ! � � � ��n� "4a r 5 4� '� , � �� .,ti „.,,� Levees ,•�,..��,t }�^� -R� K � �' � � -�s��; JTJ�, [.". ;#J,�._ , ,._ '�' l�': r'1 -� Geomarks �� 35 �� w ,r. �. ,� S „j ,; r,�-, . ' '\�+;�'r .� �.'�19 j Floodplain Analysis Lines ;-. . ,:' z"...� `*�`' ti' � kr c.� � � � n � �'�f ��Z�� "'�';,,�'"� � , � ^ -'d �� `. `� - ' ' — Case by Case Analysis for �"� � � ��/� � � '�°{y ' � '� = 'iw ; �'�T,� �� I � , E.4 , Developmenl in Floodplain < � � 4 YF:�L:J� �. 'Y�'.Y.'.�:..'S`.�: �"y- 'R�k; ��,�' �: �. � .. �F � �� •�x F�•�l� \Llr. _'k�. 5�'. . ♦ •'# . � • . .R� e � + . .w�_5 's ,s_,� r.��; r..t,Jf� � Dam Failure Analysis a ��+:�� ,riv "�rs 4 ��f�' _ t��" ��f�i��•� '. "�+;'� ,3� �"� ?' <<F,.,�� ,{,3y�- ,'�'��.. . Encroachment Analysis ',� � 'N '�`Y�� : � �4� LL'� , ...� " �`'•�r'":t ly �'�:.r :.1�. ' � . � . ��ey '{ : �e� Y 4 ri � �€ � t:�v y,�W.�, � r �Y "?� , �,E t. .�� - � '-y�� Flood Insurance Study � . • �`�',a^t '�� . "` ,.�Q ...� �A� � }y . � �S f.�x��N��. �� ` .:;5;'',('a�! ,.�"� 4�"?�y' .�,.��, #._!, .� �.�, ��`�t Flood S[orage Analysis #.r � �t trt l t ti�. f \ `� . 1 M I-•.,y�, i� .� a V' ��p ��,� t�?,� � �� s - . �-�h�j�.J '�,�� — Floodplain5tudy(Locally �'3 � r��k�' � �� a� '��' 's��.� �", � a�. �.� � Funded) ~ �°`�� ,�Y.�'� 1, �� r� ,:-:' �w �� 'D.,"��'-� � '• +� � '�fi"' , • ''�r . . �. � .�.x� t _ Hydrology/Hydraulicsdeveloped :A'� ��+''"��ry�r'�:.'� �;v . y '�. „' ��.�, f- �, � .,�t.,, ir' _ � �� at a Dam �� ,�,��d �,� �� , . ' '� � �:r.�, �' <all o[her values> ."� +�� i � �1 �'�M. �, ... "L�,.S. •�yi� ,,+ .�� _� ;,, ^ � � Floodplain Analysis t� :�as'� r ' Catchments , �',��-, s t +1�: �,�,� '�' y y �C °-' ti�a"::� . +y + .i, ` � -v � �� ' I `� ��`•� * ' �ti Floodplain Analysis Points • • , . +� ; . � ,, � ,. . , . ' . : �� .� .. f� � #+'� �.��. '? 5 ��"� ~ Y� '� ..�: .� � � Case by Case Analysis(or �4 i R`'� t�r• `�`:1.� � ,f ��l.s,�+�' ��w'S �� „m,,, ...:,..�..�, Development in Floodplain �;�' �G t �' _�� t •�� n��r 6_ y •�� .r �~�y DamFailureAnalysis � , ,(m • �s J�. _�,, p�.'- � , �r - • ��.P.,t ,'� ,.u�,, ' r�` �; � Xa'.�y _ } � .. .,'� � Encroachment Analysis �yr�� FA� �"' ,�� y�t-w'F .� �. � r �� . k 't3 Flood Insurance Study 'h,��s'�r��ipl'��` y� '��'•Y� # } ;' -�.. ",�, `�� °�Yt j #�� '+�� a;. ��.��.� �:F: 'y y ,,,�..� Flood Storage Analysis ;s • ��.x-:t;� „�C;., � '' ,�;' � . ��v. . � � Floodplain Study(Locally �� . '7.� �-' .?�� - Funded) �1 ` � , ,�, �� t� � � 5'� �:, . Hydrology/Hydraulics developed �"r'. � � . � y .;�: t 1 ' �'-r. .e��... ..�x. .�_ . _ .�`r�i� r....r .�r. .. w'. .. . YyB�:°:�o-?��:-... .si..� � Notes �.� � �.�6 �.� M1�2S DISCLAIMER T�,��e r �iivaiic�,� .v��u��,�:I�.�.e'�aps h.�.... �.�e��,n, e�i'�on,��;a�ic,i� sources,and are of varying age,reliability and resolulion.These maps are no[intended to be used for naviyation,nor are these maps an authoritative source of information about Ieyai land ownership or public access.No warranty,expressed or implied,is made regarding accuracy. NAD_1983_HARN_Wisconsin_TM �. 3,960 applicability for a particular use.completeness.or legali[y of the information depicted on this map.For more information.see the DNR Legal Notices web paye�.h[tp�..�dnr.wi.govllegal� �,, ,t` "'"E�;; PRIVATE ONSITE WASTE TREATMENT County �'�S SYSTEMS Sawyer P y ( POWTS) ��,-,_, s ,� k �_��; �"�� INSPECTION REPORT sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �3 '3 ( I Personal information you provide may be used for secondary pucposes[Privacy Law,s. 15.04(1)(in)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: c-c,� �a.�- �� ds�rz► r- Insp BM Elev: BM Description: Parcel Tax No: r �0�.� .��- a� �� o� �aks-�, ooY —?38— (�- j Yc,� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � � n�p � ��pa Benchmark (p�,�� Dosing �j ST �/� �- Aeration Bldg. Sewer - Holding St/Ht Inlet �3,�-� TANK SETBACK INFORMATION St/Ht Outlet � ,,1� TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet AIR WTAKE Septic k�s` �. � �-�3� �� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. `1'�.6S� Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative �� $ � Surface Manufacturer Demand Final Gratle Model Number GPM 5� � �tiT �$,$ r TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W �� ' #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number: ❑ AG � EZFIow CELL TO _�t� (� ❑ Mound o Other __--- - --- -- ��-- _ __ ____--- -- -- ---- -- --------- DISTRIBUTION SYSTEM X Pressure Systems only Header/Manifold Distnbution Pipe(s) 1 X Hole Size - X� Observation Pipes � Length Dia Length Dia Spac ! Spacing ❑Yes ❑ No - --- - -- --- .� SOIL COVER Depth Over Depth Over ' Depth of Seeded/Sodded Mulched Cell Center �;,ell Edges I Topsoil _ ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ��-�,�� f g/�3 � � Plan revision required?❑Yes� No p 3 �- �.� - � �cf� Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL C�MMENTS ANO SKETCH SANITAAY PERMIT NU`EA:____ 2 3'�..31� _„` � �- ,�� -. �� , �'7 P�� S� ? eX�'`� n (?o�) ` � �'lo� ` � � �� p - t tJ -,� ,�� 1 �r �7Q� . � • a � S 4P� � J �� , � o �p� y � ' �,A� %�� `� � �� f�<'`'o �� -�,�, � �� W�a�b L �"'� � � �� i � � a � �__ s�• �f �-��7o y �