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PAGE 1 OF /(/ <br /> TITLE, INDEX, AND PROJECT SHEET FOR POWTS PLAN SUBMITTAL <br /> Property Owner's Name Larry Grab Property Location <br /> Property Owner's Address Project Address(if different from Owner's) <br /> 1501 Brynwood Drive 7914 Bowman Rd <br /> City&State Zip Code Phone Number Subdivision Name or CSM Vol&Page Lot# Block# <br /> Madison, Wi 53716 608-217-2428 CSM 8524 <br /> Type of Building ❑ City County <br /> • I or 2 Family Dwelling-No of Bedrooms 4 ❑ Village Dane <br /> ❑ Public/Commercial-Specify Use- 5Cl Township of Roxbury <br /> Effluent Type Filter Details Best GF 10-8 <br /> ® Number 1 (Septic) IX) Effluent(Type&Model) _ <br /> ❑ Number 2(Highly Pre-treated) ❑ Basin Used(Manufacturer& Size) <br /> ❑ High Strength ❑ Inline(Type&Model) <br /> Component Manual(s)Used(check all that apply) ❑ At Grade Using Pressure Dist-SBD-10705-P(R.6/99) <br /> ❑ Inground Soil Absorp.-SBD-10567-P(R.6/99) ❑ Mound-SBD-10572-P(R.6/99) <br /> ❑ Inground Soil Absorp.Ver 2.0 SBD-10705-P(N.01/01) ❑ Mound Version 2.0-SBD-10691-P(N.01/01) <br /> ❑ Pressure Distribution-SBD-10573-P(R.6/99) ❑ Holding Tank-SBD-10571-P(R.6/99) <br /> ❑ Pressure Distribution Ver2.0-SBD-10706-P(N.01/01) ❑ Other-Explain <br /> ❑ Small Scale Waste Management Project Publication 9.6 <br /> INDEX ATTACHMENTS(List) <br /> Page 1 TITLE,INDEX,&PROJECT SHEET <br /> Page 2 Original Plot Plan <br /> Page 3 Plot Plan _ TOTAL ATTACHMENTS <br /> Page 4 Soil Evaluation Report <br /> Soil Evaluation Report Seal of Designer,Architect or Engineer(If applicable) <br /> Page 5 <br /> Page 6 In-Ground Gravity Dispersal Area <br /> Page 7 Observation pipes <br /> Side View of Rissy Flout Tank <br /> Page 8 <br /> Page 9 Powts Management <br /> Other pages: 10 Powts Management <br /> Total Pages This Plan 10 <br /> I THE UNDERSIGED,HEREBY CERTIFY THAT THE <br /> PLANS AND SPECIFICATIONS SUBMITTED For Office use Only <br /> HEREWITH WERE PREPARED UNDER MY DIRECTION <br /> AND CONTROL AND THAT THE CONSTRUCTION AND <br /> INSTALLATION OF THIS POWTS WILL COMPLY WITH <br /> COMM 83 W.A.C. AND OTHER APPLICABLE <br /> REGULATIONS. <br /> Plumber: Kenneth Haugen <br /> Credential#: 224121 Date 7 - <br /> Signature: 2"" " ].�Lk%' �rz /l�✓_ <br />