HomeMy WebLinkAbout24-56S* INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY '
t ;
TIME RECEIVED REMOTE CSID DURATION PAGES STATUS
June 10, 2024 at 6:27:59 AM CDT 7153724159 35 1 Received
Jun 10 2024 21:44 HP Faxpollaosla Plumbing 7153724159
page 1
Request for Sanitary Inspection
Fax this form to Zoning Dept when you want an inspection — 373-0114
if you o not have_a fax and must email the inspection; you must email all staff members
Note
Plumber.
JJ_Time Change Discrepancy
?o/k
?1k31: ?('
Other
Phone Number
? 1 -≤-' z-� z-- 14 1 4
Fax Number
-7/c 3-72.-- L{i≤9
Home Owner:
Yc S" o Lam. v" Sre K c€
Sanitary
Permit #:
Date:
Time:
Township:
Address # &
Road Name:
or
Directions
To Site:
Comments:
OL(—Z- ,§-10S
Plumber's Choice Zoning Dept No ins eation during these times
lo—t7^Z4� OK
Plumber's Choice Zoning Dept
Immediate Phone Number so Zoning
/a: ;o
OK Dept can call you right back (if needed)
to 7 St -{ o rte} J. b --er L-� `CL,
RemIn: You must confirm any change(s) that have been made prior to or
this Inane on will not he schedetled ,ice a memo will be sent voiding the Inspection.
Thank You!
From Zoning Dept
** Plumber must verify any change(s) by fax or no /ns1vectlon will be scheduled **
WIMM seniterylre astfartnspectta,
Zoning Dept (e4112104) 0 August 2021
oEc��r�
Private Onsite Wastewater Treatment
Systems (POWTS) Inspection Report
(Attach to Permit)
CHRISTOPHER A SPENCEy purposes[Privacy Law, s. 15.04 (fl(m)
220 TAYLOR AVE fl city LI Village fl Town of:
DAYTONA BEACH FL 32114
Elev: I Insp BM Elev:
Ten4 Infnrmafinn
TYPE
MANUFACTURER
CAPACITY
Prop. ' e
Well
Building
Air Intake
Road
Septic
G
N/A
Dosing
N/A
Aeration
N/A
Holding
.cethark to
°5ry -6e
Sanitary Perr No: (( NNll
State Plan Transaction ID#:
Parcel Tax No:
/' '/9C
Pump I 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
Length
# of Cells
SETBACK FROM
Pr a
B m
1N79
IQ
�/
OHWM
Ty o Cdll
ft44
Manufacturer:
Model Number:
Pretreatment Unit I
Manufacturer:
Model Number:
Distribution System
Elevation Data
STATION
BS
HI
FS
ELEV
Benchmark
00.to
Bldg. Sewer
�5
Tank InletTank
Outlet
.M'S
Dose Tank Inlet
Dose Tank Bottom
Inst. Contour
Header! Manifold
Distribution Pipe
6'1
R>{ ,
Infiltrative Surface
a3 2
Final Grade
X Pressure Systems Only
Header I Manifold
Distribute ' e(s)
X Hole Size
X Hole
Observation Pipes
Length Dia
Length Dia Spac _
Spacing
❑ Yes 0 No
Soil Cover
Depth Over
Depth Over
Depth of
Seeded / Sodded
Mulched
Cell Center
Cell Edges
Topsoil
❑ Yes ❑ No
❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, ete,)
tY �J J c, 19
Plan revision required? ❑Yes No
o Use other side for additional enforma'n.
Date POWTS Inspector's Signature
837 3
License Number
CanR71n (P nw91)
S
Property Owner
Information
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138
Fax: (715) 373-0114
e-mail: zonino(Wbayfieldcountv.wi.gov
Web Site: www.bayfieldcountv.wi.aov/147
CHRISTOPHER A SPENCE
220 TAYLOR AVE
DAYTONA BEACH FL 32114
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
As you know roo ,O/ OS%i was contracted by you to install a private
onsite wastewater tre ment system on your property described as:
Notes:
Abandonment of Old System to meet all applicable code requirements:
LII
Tank was pumped by:
Tank was crushed / removed and pipes disconnected by:
on
at AM/PM
On Jo,47,7 I at /0/3, (6) PM) the above -mentioned plumber contacted our office to
conduct a pre -cover inspection as required under 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
is necessary because the installation was substantially different than the original approval.
❑ System 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:
U/form s/senitaryprapertyowneninput
April 2019