HomeMy WebLinkAbout24-54S** INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY **
TIME RECEIVED REMOTE CSID DURATION PAGES STATUS
June 10, 2024 at 1;46;36 PM CDT 7157983470 37 1 Received
JUN/10/2024/M0N 12:31 PM Andry Rasmussen & So FAX No.7157883470 P. 001/001
Request for Sanitary Inspection
(Fax this form to Zoning Dept when you want an inspection — 373-0114)
Note: Time Change Discrepant
From Zoning Dept .Y 0th er
Phone Number
Plumber:
Fax Number
7lS-7qb-3y70
Home Owner; U C
Sanitary b-�/!
Permit#: d`t
Plumber's Choice Zoning Dept No insoec
Dafe:
I I cb� �� OK 9.30 am —12:30 pm Tues. (Tracy)
�`"(� 9:30 am —12:30 pm Thurs. (Tracy)
Plumber's Choice Zoning Dept
Time: Immediate Phone Number so Zoning
n/-�fj Dept can call you right back (if needed)
OK
Township:
Address # &
Road Name: (1 [�
or R9 on ii/u: : .oi
Directions
To Site;
Comments:
l Reminder; You must confirm any change (s) that have been made prior to
this insoection awill not be scheduled and a memo evil/ ba sent soiling the in�oection. or
-- — --- — — — --- — -- — Thank You!
• lumber 011/sf varl/y any change(s) !.l y rcX or no In$j gCt10i, 4'/!1i he,schado/ee!
w.
oEpurnr
Private Onsite Wastewater Treatment
sps Systems ( POWTS) Inspection Report
(Attach to Permit)
Industry Services Division
ERIC M & CHRISTINA J FURSETH
350 S HAMILTON ST
UNIT 403
MADISON WI 53703
Infnrmatinn
.eafhark fir
Sanitary Pe No:
-✓4$
State Plan Transaction ID#:
Parcel Tax No:
TYPE
MANUFACTURER
CAPACITY
Prop. Line
Well
Building
Air Intake
Road
Se tic
e C
0
N/A
Dosing
N/A
Aeration
N/A
Holding
Pump! Siphon Information
Pump Manufacturer
Pump Model
Demand
GPM
Filter Manufacturer
Filter Model
TDH
Lift
Friction Loss
Head
Total
Forcemain
Length
Dia
Dist. To Well
Dispersal Cell Information
DIMENSIONS
Width
Lerygtta
#ofCe
SETBACK FROM
Pro�J�,ine
J
BuuJil�d' g
War
/
6tiWA9
(/
Type of Cell
'
Manufacturer:
Model Number:
Pretreatment Unit
Manufacturer:
Model Number:
Distribution System
Elevation Data
STATION
BS
HI
FS
ELEV
Benchmark
, Z
03.2
Bldg. Sewer
3
eta
Tank Inlet
$ %
Tank Outlet
i[g
Dose Tank Inlet
Dose Tank Bottom
Inst. Contour
Header/ Manifold
•q
Distribution Pipe
Infiltrative Surface
4ty Z
Final Grade
ctrl
X Pressure Systems Only
Header / Manifold
Distribution Pipe(s)
X Hole Size
X Hole
Observation Pipes
Length _ Dia
Length _ Dia Spac _
Spacing
O Yes ❑ No
Soil Cover
Depth Over
Depth Over
Depth of
Seeded / Sodded
Mulched
Cell Center
Cell Edges
Topsoil
O Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
ren/JPf5, ` d/' &
d cAa"r5
Plan revision required? ❑ Yes�NoI /� // Z,
mfa
Use other side for additional Infot on. a '(
Date POWTS Inspector's Signature
/ 2373
License Number
cans7tn rrz m191\
Property Owner
Information
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138
Fax: (715) 373-0114
e-mail: zonina(a)bayfieldcounty wi.gov
Web Site: www bayfieldcounty wi.gov/147
ERIC M & CHRISTINA I FURSETH
350 S HAMILTON ST
UNIT 403
MADISON WI 53703
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
As you know F%as,'f'U# itJ 4 . iP CI was contracted by you to install a private
onsite wastewater treatment system on your property described as:
Notes:
Abandonment of Old System to meet all applicable code requirements:
I
Tank was pumped by:
C. Tank was crushed / removed and pipes disconnected by:
on
at AM/PM
On C".2/,"A V at 2 £'1 (AM eabove-mentioned plumber contacted our office to
conduct a pre -cover inspection as required iIffBer DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
System was inspected and appears to meet all applicable code requirements; however, a plan revision
L , is necessary because the installation was substantially different than the original approval.
USystem could not be inspected because plumber covered prior to scheduled time of inspection.
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
County was unable to return to complete inspection.
System could not be inspected because plumber was not ready at scheduled time of inspection.
A re -inspection and $50 fee are required.
System could not be inspected because County could not respond to plumber's time constraints.
Comments:
W forms/sanilarypropertyowner-input
Apri12019