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Illtcommerce.wi.gov County <br /> : //��►► Safety and Buildings Division Dane <br /> I s V O n s'n 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(tilled in by Co) <br /> Department of Commerce Madison,WI 53707-7162 13-2015-00307 <br /> Sanitary Permit Application State Transaction Number <br /> In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate <br /> govemmental unit is required prior to obtaining a sanitary permit.Note:Application forms for Project Address(if different than mailing) <br /> state-owned POWTS are submitted to the Department of Commerce.Personal information you 2489 RINDEN RD <br /> nrnvirie may he'iced fnr cernnriary nnrnncec in arenrrianre with the Privacy I aw c 15 04(11lm) <br /> I.Application Information-Please Print All Information <br /> Property Owner's Name Parcel# <br /> AMERICAN TRANSMISSION COMPANY LLC 0611-091-8500-5 <br /> Property Owner's Mailing Address Property Location <br /> PO BOX 47 <br /> , Govt.Lot <br /> City,State Zip Code Phone Number NW t/4 NE '/4 Section 9 <br /> WAUKESHA, WI 53187-0047 (circle one) <br /> T 06 N; R 11 E <br /> H.Type of Building(check all that apply) Lot# <br /> ❑ I or 2 Family Dwelling-Number of Bedrooms Subdivision Name <br /> Block# <br /> E l Public/Commercial-Describe Use Office and utility tec City/Village/Town of <br /> ❑ State Owned-Describe Use CSM Number TOWN OF PLEASANT <br /> SPRINGS <br /> Ill.Type of Permit:(Check only one box on line A.Complete line B if applicable) <br /> t <br /> A. ❑New System 0 Replacement System ID Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explai <br /> List previous Permit Number and Date Issued <br /> B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumbe ❑Permit Transfer to <br /> Before Expiration New Owner - <br /> IV.Type of POWTS System/Component/Device:(check all that apply) <br /> ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At Grade IZI Mound>24 in.of suitable so ❑ Mound<24 in.of suitable soil <br /> ❑ Holding Tank ❑Other Dispersal Component: ❑Pretreatment device: <br /> V.Dispersal/Treatment Area Information: <br /> Design Flow(gdp) Design Soil Application Rate(gpdsf Dispersal Area Required(sf) Dispersal Area Proposed(sf System Elevation <br /> 3594 0.6 5990 6776 963',961.5',959.6'. <br /> VI.Tank Info Capacity in Total #of Manufacturer °t <br /> Gal ons , Gallons, Units a `r U °Y w o <br /> New Tanks Existing Tanks o ? a m m <br /> a. O N in co it 3 a <br /> Septic or Holding Tank 7700 7700 1 Wieser ✓ <br /> Dosing Chamber 1250 1250 _ 1 Wieser _ ✓ _ <br /> VII.Responsibility Statement- I.the undersigned.assume responsibility for installation of the POWTS shown on the attached plans. <br /> Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number <br /> Jeffrey Hammes Permit application completed online 1171 (608) 233-9200 <br /> Plumber's Address(Street,City,State,Zip Code <br /> 820 Williamson St. #401, Madison, WI 53703 <br /> VIII.Count /Department Use Only <br /> Permit Fee Date Issued Issuing Agent Signature <br /> El Approved disapproved <br /> ❑owner given reason for denial $1,577.00 09/28/2015 Richard Herro <br /> i <br /> IX.Conditions of Approval/Reason for Disapproval <br /> Existing septic system to be properly abandoned. <br /> Protect mound system site and area 15 feet downslope from soil compaction,soil excavation,and vehicular traffic. <br /> Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size <br />