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HomeMy WebLinkAbout024-841-01-1309-SAN-2023-312 _ •;;-..3�.rr�-- � � =�� --- In�us�y Services Division eounn' � = 4822 Madison Yards Way ,f W � ,:: �D.S = Madison,VI'I 53705 Sanitary Pcrmit\umbcr(to bC filled in b��C � p= : P_O.Box 7]62 l" � ";;;��_`-z- Madison,lVI 5707-7162 �I J � ��� � W State Trsnsaction i�`umbcr W Sanitary Permit Application � [n accordance u�th SPS 333.21(2),tVis_Adm Code,submission ofthis form to the appropriata governmental unit is requircd prior to o6mining a s�nitary permit Note:Appfication fotms for sbte-o�cnecl PO«'T'S are submitted to Project Address(if diIIeruit tt�;u�mailing add:c�s) the De��attm�ut of Safcty aud Prof�sional Scn•iccs.Pc�onal information you proti•idc may bc vscd foz sccondary purposes in accordance�rith[he PrivacyLaw,s.15.04(1)(m�,Stats. I_Application Information—Plcase Rriut All•I..nformation - �qm( Pr�pem•O«•nc%�\ame Parccl;� ,� �v/�'e a�y y o i a� :operty O�an�r's�faitin�Address Propertv Loca.ion / w � � { Govt.Loc `' Cin,Sia�c "Lip Cocic Yno:ie\mnbcr N W l�✓.Z � ���.�`�, Sectios_ � II_ ype of Building(clicc3:aII_t2iatapply) Lo4� T y N R L or j �1 or2 Faiuih ll�cdlino-l�umberofBcdrooms L, Subdivision 1`amc Blocic= �bliclCw.:im�rcial-DcscriEe lisc �� ❑City of --- ❑Stztc O�:med-Dcscribe t�se CS,LI\umbcr -illage of _ � �7'onn of Ot/.I/c�L /(�__ 30 � - �,f III.Typc af POZYT"5 Permit=(Check cittier"1\ew"�or"-ReglacemenY"and ottier=applica2�le on iine A Cfieck one b�z ori lirie B.Gnmpletc line C if a lieahle.) � I❑Nc��S}�;tem ��eptxement System ❑Other�4odification to Existing System(exglain) ❑Addirional Psetreatmenc Lnit I e�plain} } � � F B� �❑Hoidin!,7'anF; �In-Ground ��t-Grdz �i�Sound Individual Site L�esi�m �Oiher T cx lainl ?'P�t P (convcntional) t-• ❑Reneu•a{Beror �❑Re�-ision ❑Change ot Piumbw ��f'ransfer to New O�vner List Pre��ious P::m�ii\u�nbe.:v�d Datc lssi;cd F:��������,n i I o o - //-,��- 9 , � � .. _ _. . .Dispersalll'reatment Arca,andTank 7nformahou:;, �-- - . =- - _:;; ;_� -- --- Desi�m rlon�(�d1 i D�ci�n Soil applicatier.FLfc(gpd:'st) Dispcisal Area Required(s� �Disge�al rlrea Proposed(sf� 5ystem Ele��atian a U Z . 7 � � ,, � o0 9%o , ! Capacity in } ToWt �of h4anufacturer � � G � Tank tnto;matiozi � Gal3ons Gailons Un��s � � o v � � j \cl�Taui:s ExistingTyit•s � � � o u C � ! � J 'r ' .-. U v; �: ;r, t - � c.; � Scptic :Ho1J+ng'fank DO '�s� t�J�'J/'� % %i.r �✓C���/ .(/el✓ I✓ � i Dosin�ChamF�r ! � � '� � V.Responsibilit}-Statement-I,the undcrsiened,assumc responability for insLilia�on of the POWTS shosvn on thc attachcd ptans.-, P(umbcr�s Name i;P:�ni? P(umoer's Signaturz •t �4PKS Number Susincss Phone tiumbcr � v' 0 7/S ' 3-�i3t F'lumber's:\ddress(Strcct,Cin-,SGuc,Zip Codc) / 7 .�/ ,�d w z'. . __ .: .. ._. .:. _ __ : .. ,. t'I.Co ntr-!Department Usc Onlv ' . :: .., . .' _.., > = , �{ Permit Fce Date lssuzd Issuing Agcut Signahuc 1Zv,App �� Q Dis�pproved .� �/ j s�c�,� , � �- �s f�� � �2��ir��.0�.t f��- � �fltieucr Given Re:uron for Dcnial Conditions o�Approval;'Reasons for DiSapproval � ,_7��„�� r"A �f� �,R !� _ ��,(1i �`.�� �' =� �� f 1 ' �� ,�� F I � ����..�..- �. r��_1� � . F. . . W ii� �� • `� 4 1���`.�i�. i� - ; � :�,k# _� �� c��o ��`�� oEc e � ?az� % C S T �'�I— �6� : � - -- --- _ ��.�� � _ _.._. a, � � �'T�ATf rlttach m complede plans tor i6e s}stem and suM1mit io the Couaty only on pager eot hss ihnn 8 tl2 z_li iuehes in s'ize L(O I S� �Q�V��D���� SBD-b398(R.03/21} �S���?F���I �`�nxryF;`� Department of Safety and Professional Services ,,'t-- . r �i �'\���� Division of Industry Services �e%� \�� Plumbing Produd Review 3� � ��� �� �i�� 4822 Madison Yards Way 1 � P � � � P.O.Box 7162 ��t\,� ` +�� ��f � �„ Madison,Wisconsin 53707-7162 \�. �.-__:;/ �?�FFS'''l>\*`,v? Phone 608-266-2112 Web ht[�:/ dsps.wi.�ov 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 Johnson-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) Mode� 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 Statutes. 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 Wastewater Treatment Systems Version 2.1(May 2022-20Z7). Plans 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 shalf 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. Cleanouu 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 service,restaurants,tavems 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 382.34 Wis.Adm. Code. 10. DSPS POWiS plan approval shall be obtained trom the department's Private Sewage Section,or the appropriate agent tounry,for: a. each installation 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 sanitary permit shall be obtained,in accordance with s.SPS 353.21 Ws.Adm.Code,from the county,or other lotal authority having jurisdiction,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 sys[ems designed in actordance 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 result from its use. Sincerely, Brad Johnson—Section Chief Department of Safety and Professional Services Bureau of Technical Services Division of industry Services Phone:920 492-5605 Email:Bradlev.Johnson(a@Wisconsin.Rov David Arnett & Julie Brandt Property Owners Name 12386W ST. HWY. 77 Property Address 24841011306 Tax Parcel Number Sawyer County SW-NE-L.2-CSM 30/211-#7587 Legal Description 1 Section 41N Town 8W 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 .P. 220498 Plumber's License Number 715-943-2382 Plumber's Phone Number 12/4/23 Date S1�0 - l070 - S- - V'� . I Page 1 of 7 n- roun oi sorption - - Component Manual Used � _ . Version 2 • 1 -.i•t - S- z 7 4 Number of Bedrooms 2 Percent Slope (%) 80> Depth to Soil Limiting Factor (in.) 0.7 In Situ soil application rate 400 Estimated Wastewater Flow (gpd) 600 Design Wastewater Flow (gpd) 1 Number of System Elevations 91 .03 Proposed System Elevation #1 - Proposed System Elevation #2 - Proposed System Elevation #3 94.8 Original Grade #1 94.8 Finished Grade #1 - Original Grade #2 - Finished Grade #2 - Original Grade #3 - Finished Grade #3 ' �.sT��✓ 7,f'n w c+ � Skaw 800 Septic Tank l;fr r,'„ 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.) 3 Rows of Chambers 3 Distance Between Cells (ft.) 12 Number of chambers in first row 12 Number of chambers in second row 12 Number of chambers in third row 36 Proposed Number of Chambers Used 857.1 Minimum Distribution Cell Area Required (sq.ft.) qoo Distribution Cell Area Proposed (sq.ft.) Page 2 of 7 Uw,�eP �lumhe� 1J aJi l G rNe7'r �Av���;tce,v�/y ly�y� Y J0I'e 1�Rau�(f �Z?yb w Sf.ywy l� �ke/4,v�wr yo �4Yw4Pd�u�1.34frYj 7/�y3 �j&'�''���doy9� .�,vSE HouSeS�zc.l�ra�,t 3So.,._ Q "�nfTaflsi[ � �eil ti Gafa€� yedr — ' — — oa. • �� ,SR� --� �, I ( ( P?SW.✓E � �fa`,,4J5° ,� Lnr� �, ) -� a f. 1 � y,,o,� �,it<< y,gj � I.4iN N�W H R,yw ' y°o y, S.JJf ( �� �aq���ed4yvloll3oL I �b w'�ROU.vAL4H( R Jm7o�d11-75"y7 I '* aXST�wj�y.o7a�/I( "' 1��Ta„``�f°°S�W ,<< � � q� �at�ru. 'Jtrfw�µa, � . �!7-yy,j� ��O�K ✓(V1 �'y-yN��� - - - �5t'4N.a" — — — �� 95.6' yo �k? �d � Scaic��'_voi I 3 v5''' � Cross Soction of a Three Cell Inground Component Using L,eaching Ciu�mbers Finished Grade - Original Grade - ������ Top of Chamber #VALUE! f �System Elevation - � Finished Grade 94.8 Slope 2% CF.� epara i r — ___, Finished Grade� \� �3 Feet 94.80 Original Grade � `,C�` ��'� g%�,%; �' t : . � � l �• ,� . 92.1 1 Top of Chamber ' `., '-�y �y.�� Original Grade - ••..... -•••••• - ,., y . . ; ;,; _ � ' � - �� • : .. ., '� , � �, Top of Chamber #VALUE! 91 .03 System Elevation '� r.%.,..;, r ` • • �• y System Elevation - ._�_ � • , .... ,� � ,_ .. . _ •• •: _ • '�..: : t'��d�:� .�.; :.•. :,::� ' •: ::� --�: ;• ',-;��i�;,•j . .�'�t" .� �. '� � �� �.r.�� . . . ��� '- . . .�. ,�'.. ' . . �' � •� . � ' r. �'. -. , .•. . . � .. • , . • '�� � .� � � I `. �t�� " •�. '� . . . ..v.` 5.._ .—�____.. . . �YifbONl�p�lti b b0 O�hIC��C�f)Od p�1b t�OV'Od�Yb�IbC�1LC. Diagrams Not To Scale � 62.34 feet n - --- - _ _ ___ - _ _ -- ---- - --- ;f � : �- a -�. �.�.. �..� �► � ..�f . � � � � Q '� _ � � � � . ' _ p � i . � L _ � ' &:�' � ���� ` �' � Gx � - � _ . _. ....._�.. �� / � ' � 62.34 feet : _ � _ __ _ . _ ,:;4 $ ,���w�;� ��� � _ :�,;.- : -_`� 3 feet _ ,r. .. . � � _ � ; � � .. � _ ; ; , , :� � , �..� . _--� � �_ , � ° befinreen cells ; ,_ _ _ _ -- � =� � ' I ' � �. - __ --- -- --- -_ , , . _� � . . � � , o� �'"� o� � � �a S�i � . � . _ � --- �►�� .� , � -- _ . _ __ ; � _ - - - - - - - --- - - _ 62.34 feet � Observation ! Vent Pipes to be located at the ends of the distribution cells. Page 4 of 7 �WARNING: DEATH MAY OCCUR IF TANK IS ENTERED WITHOUT PROPER � �i SKqw �oo � EOUIPMENT j O �� i I I I I o I I I I I I I I I I I I I I � 61.00" -� I I TOP VIEW OF MANHOLE COVER i � i i i i � i i i 1 I I �3.00 ' f I I L__��_�_�_��_____���_�__�����___J 4 0��� �—�� OUTLET END VIEW OF TANK z�.00 2�.00 I 24.00 24.00 5.00 ❑ I �1 � 16.00 �1.00 � INLET 4 O �� 9.00 OUTLET 4'PHESS SEAL I'PNESS SEAL CASKET OASKETINSTN.IED ._ ___ __._____._.______.______..._..._________._.______.___________.. _.____...____ _ NFIEN PWRED � 'I B.00 2.�� � BAFFLE FILTER 40.00 � � �3.00 SECTION VIEW OF TANK & COVER PAGE: 1 OF 2 MODEL NUMBER: 800 S KAyV P R E-C A S T pHONE: (715) 987-2277 APPROVED FOR: SEPTIC, SIPHON, HOLDING, OR PUMP TOLL FREE: 1-800-924-8825 26255 105th STREET, NEW AUBURN HOME PHONE: (715) 987-2306 WEIGHT INLET DIM. OUTLET DIM. LIQ. DEPTH GAL. / IN. MAX. CAP. WISCONSIN 54757 FAX: (715) 967-2707 (SHOP) FAX: (715) 987-2708 (HOME) 7,930 LHS. 45" 43" 40" 20.12 805 GAL. , David Arnett&Julie Brandt 12386W ST. HWY. 77 2.48E+10 Number of Bedrooms 4 Septic Tank Skaw 800 EStlm2t6d FIOW{average)gallons/day 400 Effluent Filter �,;F e t�m c Design Flow�peak},(Estimated x 1.5)gallday 60� Soil Application Rate al/da /ft2 0.7 � Influent/ Effluent Quality Monthl Average PRINT PAGE Fats, Oil & Grease(FOG} 30 mg/L ----� Biochemical Oxygen Demand (BODS) 220 mg/L Total Suspended Solids (TSS) 150 mg/L !!NOTE!! Servicing frequency of 12 months or less requires the Management Plan be recorded with the Register of Deeds. Maintenance Schedule Service Event Service Frequency Inspect condition of tank{s) At least once every 3 Year(s) Pump 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 studge 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 etFluent 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 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 Oqeration For new construction, prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals 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 7 r Do not dnve 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 all 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 filied 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) QThe site has not been evaluated to identify 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 location 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. Failure to protect the replacements area will resutt in the need for a new soil and site evaluation to establish a suitabie 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 replace 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 result. Rescue of a person from[he interior of a tank may be difficult or impossible. POWTS Installer Septic Pumper Name Bruce Vitcenda Name Northwest Sanitary� Phone# 715-943-2382 Phone# 715-943-2650 POWTS Maintainer Locai Regulatory Authority Name Northwest Sanitary Agency Sawyer County Zoning Phone# 715-943-2650 Phone# 715-634-8288 7of7 ._._.�_..._�. • - .... .... � , � . . ... .. ..... I . ... . ... .. . . � .. .. ...... ... . ... _____�___,_ , . ... .... .... ... ,..... ..., ..,, ., ... .. ... ... ,. ... ... .... -- _. .... ... ... ..., .., .... ��i .. .... � � .�$ . .. .., .,,.. L � sw '�°��� $�' fi ,. ,,, . . .. S� , 3 -�g� [ � j w L ' f w . :,.: .'.. : b'$$ S�g'� . .. .. , " 6� I� �'b$ ,�'b� :.. :. f,�, Sw �"w. c � —` °b S7 i� i , E �•ab .f' ob �9.�—' � , f 9 L • � ��•ob . £,�y �� ,�o��b s � __� ' L • _ -__...i_ -- Ib _ .., ... .. . L ' � y .... � 7 S7 ,ti r73 _. � � --- L � _ rh � . . f' . ... . . . . , . ..... .. , r ti ,. � ... . �'� , � �lth �s : : :" S' � ... .... 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N.�P. � ... .-� --- --. ... ... / Z° .. .. .. ... a-3� ... ... j .._ ... t3 � ... ... ... ... �I -. ... � / ... _ ... � ... ... l-3� ...... .. ... ...... i ............ , ..... --�--- _88.03� ....._...... � -�7.`�> � ......:... ---- -..._ .............-87,7 .......... .........._. . ..... ...... i .........._ - ...... .........._ $1 �� .... ...:. ........... ::::: :::::: 12/4123,8:40 AM Real Property Listing Page •Redl EStdt2 Sawyer County Property Listing �roperty Status: Current Today's Date: 12/4/2023 Created On: 11/7/2008 2:15:59 PM �Description Updated: 11/17/2015 � Ownership Updated: 8/14/2009 TaxID: 40155 � �� DAVID ARNETT � HAYWARD WI PIN: 57-024-2-41-OB-OS-1 03-000-000060 ]ULIE A BRANDT HAYWARD WI Legacy PIN: 024841011306 Map ID: 3.6 Billing Address: Mailing Address: Muni�ipality: (024)TOWN OF ROUND LAKE DAVID ARNETT DAVID ARNETT STR: 501 T41N R08W 12386W STATE HWY 77 12386W STATE HN/Y 77 Description: SWNE, LOT 2 CSM 30/211 #7587 HAYWARD WI 54843 HAYWARD WI 54843 Recorded Acres: 5.120 Calculated Acres: 5.442 � Site Address * indicates Private Road Lottery Claims: I 12386W STATE HWY 77 � HAYWARD 54843 First Dollar: Yes Zoning: (A-2)Agricultural Two � propeKy/lssessment Updated: 7/16/2019 ESN: 461 2023 Assessment Detail Code Acres Land Imp. �� Tax Districts Updated: ll/7/2008 G1-RESIDENTIAL 5.120 23,700 176,500 1 � State of Wisconsin 57 SawyerCounty 2-YearComparison 2022 2023 Change 024 Town of Round Lake Land: 23,700 23,700 0.0% 572476 Hayward Community School Distrid Improved: 176,500 176,500 0.0% 001700 Technical College Total: 200,200 200,200 0.0% • Recorded Documents Updated: 8/13/2009 � PERSONAL REPRESENTATIVES DEED � � � �L4 Property History Date Recorded: 7/28/2009 361869 parent Properties TaxID 57-024-2-41-OS-01-1 03-000-000010 26424 57-024-2-41-OB-D1-1 03-000-000040 26427 57-024-2-41-OB-01-2 04-000-000010 26433 ['hild History Rerord Caunt� 3 - HISTORY O Expand All History, White=Current Parcels Pink=Retired Parcels O Tax ID: 26433 Pin: 57-024-2-41-OS-OS-2 04-000-000010 Leg. 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Division otSnlery 8 Buildirgs in accord with ILHR 83.05.Wis.Adm.Code COUNTY � Atlach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but -��`�'"� �v ' not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL i D a .3���� dimonsioned,norih arrow,and location and distance to nwrost road � 'I; - �—'+'- APPLICANT INPORMATION-PLEASE PRINT ALL INFORMATION REVfEWEDeY DATE �1 W Ha�... ll-14 4� PROPERTY OWNER �[ L PRO?ER'YLOCATION . �(.41.�✓4 �%'7i J�l< ^ GOVT.LOT - i ,'� 1i4 D.1'-.t/A,S 1 T y� N.R SS E(�- PROPERTY OWNER�Jv1AIL;NG ADDq�SS LOT x BLOCK n SUBD.NAME OR CSM a '�I 15 OX ���`Z �.l-� cs»�,�o�>!1 CITY, TATE ZIP ODE PHON�NUMB ❑CITY ❑V LAGE �fOWN NEARESTROAD ��'u.�„��•-� C��� �r � sY3 i y ��'-:�'1° �c•�,..-; ,c..�� i .. �i�7 � New onstroction Use�k� ResidenUal/Number ol bedrooms � h.' ( � Addilion lo existing building [ ] Replacement ( � Public or commercial describe ----___._ _ _ _-- Code derived daily Aow ��'�' gpd Recommended design loading rate ' � bed,gpd/fl2 -`�trench,gpd/ft2 Absorption area required ,f� bed,ft2 �`77 hench,flz Maximum design loading rale� bed,gpditt2,__�_trench,gpd!ft2 Recommended infiltralion surlace elevation(s)_ _�1� � �R(as.�relened/to site plan benchmark) AddiGonal design r site considera6ons 3 �--�-�.�--^-^;--�-� �y�� �-tSr-�'�l�.�c •�Y-c�-�-��-�--^-#� Parent material C G-c.�.,l� l i I� _Flood plain elevation,it applira6le �' ft , '� �ai.2 S=Suitable lor system CONVEMIONAL K ND 1Y GROUND PRe55URE A7 GSADE SVSTEh1 IN FILL HOLDING TANK U=Unsuitable lor s stem �s ❑u �s ❑u q s ❑u �s ❑u �s ❑u �'s f�u SOIL DESCRIPTION REPORT Boring# Horizon Depth Domina�t Color Mottles Texture Structure Consislence Barxtary Roots GPD/it ��;,�.;:::::� in. Munsell �u.Sz.Cont.Color Gr.Sz.Sh. Bed � � — - -._.__.-- - --- - _--_ ___ _- -_ ---_ --1-- � !�-(c 7�r<3 U S/ �1�' s� nv v�r c.1 �2 .G Ground 2 �0`3 �.�i�`f�3 /9c7�-+ S� '�'s N K �ry✓fv 5 '.� S ' .� elev � �s�t. 3 ,Z— _ YR `{/ /1 /S m sbr: �/ 5 — �7 -`� Depth to � (A,?- �/Q y /Lfiv�� P7 S �r�+5 ✓9� p 5 - '7 I -yS limiling _-- _ ----- -! _- — �---- IaClor,��p _ �n� Remarks: "Sc�--.�_ _.:�^�5 -- Boring It -- _ - --— - ,,;�.. � U' '� 5/ /L j/L ►?O�.< S/ �Z� M�✓ C�iu � •s:• � 2 6-3¢ �R N/3 vtc� S� >hK _�✓I✓Fr-- 5 .� �i' �� Ground — -- - - g�ey 3 y • S ��/'f /�c�i �s s . �'?� 5 .� Y`�'y It. Dep�h Io `� - 7.�r� y/ l�lG'�U2_ /yJ S l 11.+7 5 � � � Iimiling factor , ,, I ��b Remarks: CST Name-Please Print / p Phone �7//"� �,/_ �/.-7/S ^Ll � • �Ltl _t�� � � C ��� /� �7C � �( ����y��3 Address' - f�dX �7/ / �a._�`r � ' Signature: /� � Date�. �///5../ CST Number: (/���� �_ S� C's i�Af�CH'S PROPERTYOWNEF n m✓D-/'���-- SOIL DESCRIP710N REPORT Page�f --S PARCELI.D.p /� /�F Boring f! Horizon Depth Dom�asteColor MotVes TexWre Struclure i�nsistence 8ardary Roots GPD/ft� � Qu.Sz.Com.Color Gc Sz. Sh. Bed Trendi ?, :; _ - -- — r �<::.<:�_;::;: � ��(� '7 '� � j/ ►4c,s-t S� a �F �,� Tr GttJ o1� ' 'G c�oo�d Z 6'' S 7 �57.� `�/ `ra.�.� S� w�sd r ,,.,✓�Fv 5 1 �' • 5' ��� eley. ' --- - , ���. 3 3� c� 7 r7R `�� y� s �,-t st fi 1 � s — . � : • � �eP�h�o __� � - _ 7�Y/� y n d�- �s � S � r � - . 7 ; . s limiling - - � ------�- (BC�Of� n _ . ... _ —- � Remarks: ______- _ ___ Boring # � � ',__ I I , ---?--- __ _...- {- ..- .. __ _ ..._._. - --�-- ---- � � i � � I • �:,�. . .__. .--. _ ._---�. _ _ .._ - - --- - f 7 5�.��i t�o•,.�---- 5 � �z � r .� �F'r �./ ,z-� . ���.� Ground - - -- e ee. 2 ��, f�.c`�/ /(r/u+ l r� S6� ✓ ✓ Q5 __ ��` . S: •G y�y_llc '/ -- -- C Depthro �i �° Z 2Y �(/N-�_-- - $ N'�5�7/-C f'!� �S - • 7 ' .If - �- limi6ng -- — C 7 {I R � N d�!' I r'j QiN S /!'1 � s - • � - � �� - I - -� � — i _ _ --- lactor G ,, � Z Remarks: Bonng q � , - _ _._ __..._— _ _ _ -- —- -- -- - �S/. - � U� 7S �C3/ `,�y _ _ � a '� ✓ �'✓ i�w �5�� 4 c�o��a � � 3 _�� ��,e �/ rua�., - -f'l �,�,s� _ ,•+✓�f-; /�' •y" �� �e v 2 - 2 . �;/1 �{ /�Cl'u `5 y�t s { � / i � - . ' �fl �'tt. J Depth to �! , 7- � 7(�� � /l ors- � S �r'" � � / 5 � 7 ' ` � IimiGng � ���i _ _ - - _ _ ' - --- Remarks: Boring q i -- I --- ---- _ _;_ �: Ground - --- -- elev. It. � Depth to ------ limiling '�, tador -- Remarks: cun.aaania ncioo� . � � ��� � /�lC�� � 5/�/9�l �/� s � . . - �� �i p� . � ��: �.�e �C�� ��X »s� �r,�-�� I��,-c�- , �j.�(, � �` . �� �� �r�-•j� -S / �{� '�� .0 8 41 '� �ov. 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