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012-771-00-1320-SAN-2020-021
: � � ' . , �7� 1� � � Officc of � - �'��� �'�,�� Sawyer County Zoning Administration � ., :.'-'"� 10610 Main Strcct Suitc 49 � � ',��� � � .. �ij� �°�i ' ''rl;��: "�������i Hayward, Wisconsin 54843 � ,�, �''- +�ER Cp (1 (715)634-ki288 1`3 "t���� :^i�, =s1 j G�I� FAX(715)638-3277 � r � L'viO� %Q' .�� www.sawvercountvgov.org ���� �� `.�.�\� �V1I . '�� E-mail:zonin .�(d;sawYcrcounty�;ov.org i ;:., ��� OJ�Q�,, ;� � = '�� Toll Free Courthouse/General Information 1-877-699-4110 i , / (� r� ' I����s y 5��� .�'��^�"'�..,�q"�'�'' '��j`'���` �����oN�� ��.���P �-�� SAWYER COUNTY SANITATION DEPARTMENT TEMPORARY EMERGENCY TANK INSTALLATION APPROVAL PROPERTYOWNERSNAME: S,QAr-z�S �aw„��. LL� TOWN OF: ���� ADDRESS: ��a S( W 1�q.�— W1�s�y �. � � I, �C �c�,.,,lo( /"�-er-..-� � , a Wisconsin Licensed Plwnber, authorized by the owner, do hereby acknowledge that I am receiving temporary approval to install a septic tank/holding tank without a soil and site evaluation, or existing system evaluation, and private sewage system plan review due to inclement weather and/or health and/or safety emergency. Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and private sewage systein plan review will be conducted by the deadline stipulated by the permit issuing agent, or as soon as weather conditions or circumstances permit If the private sewage system is found to be failing as defined in s. DSPS 381.01 (92), Wisc. Adm. Code, corrective measures will be taken as such that the private sewage system complies with all applicable requirements of chapter DSPS. 383, Wis. Ad�n. Code, within 90 days of this agreement. I further acknowledge that failure to comply by obtaining all necessary permits after the deadline date may result in the issuing of a citation, under Section 11.3 [2) Sanitary Permits], of the Sawyer County Citation Ordinance. DEADLINE FOR THIS AGREEMENT SHALL BE: j�S(O( ��� Signed: ►����%�l//�� Date: O r3-� a.ba-6 Accepted by: ��,_. �� ��— Date of temporary emergency approval: 03-��ra-e� Rev. 03/26/13 ���°'R'`'���r;_ PRIVATE ONSITE WASTE TREATMENT county ��� "� SYSTEMS ����SPs� �� ( POWTS) Sa.Wyer `�,\,�, ���`--;;:i - � INSPECTION REPORT sanitary Permit rvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION oZC� _p� � Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Hoider's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: 5 �a��l t« �-lu,,�' P��-o3aoob3��- c Insp BM Elev: BM Description: Parcel Tax No: (pl7��� �a i� �/� 1�C c/ l�-���� ��y� �1,2 -� (—o o- l 1 O� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �po,o' Dosing � Aeration Bltlg. Sewer Holding St I Ht Inlet . Y�' �,�j• �g TANK SETBACK INFORMATION St I Ht Outlet $', � " (9�},o ' TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet AIRINTAKE Septic NA Dt Bottom �.$3 � (o�g7� Dosing NA Installation � Contour Aeration NA Header/Man. Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface Manufacturer G � Demand Final Grade Model Number GPM I 1$ y,�' � 70,�' TDH Lift Friction Loss Sys Head TDH Ft �� ,3 � 70.� � Forcemain L Dia Dist. To Weil �9 .(� 3�.� ' 6 6.8 � DISPERSAL CELL INFORMATION DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate P/L Bldg Well ❑ �GP ❑ Chamber INFORMATION Waters � AG ❑ EZFIow Model Number: CELL TO ❑ Mound o Other -- — ---- — ----- --___ __--- - _ DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac � Spacing ❑Yes ❑ No �---- - -- -- - SOIL COVER f Depth Over Depth Over Depth of Seeded/Sodded Mulched � � Cell Center Ceil Edges Topsoil _ _ ❑Yes ❑ No O Yes ❑ No COMMENTS: (Include code discrepancies,persons present,etc.) I d� � � CO�� ��.V` J— Plan revision required?❑Yes ❑ No b�/ �c� �a� �—�� � ��-�'� �� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) — - L�d;S � � �� �� ,.�o' '� s��d�j ���,� � a�j«��i ���� �-Lj� �a�M � b 11 ` O ,� � _ �� , i � �HaP o — ^ �' �V, Qh � ��1 / � � oh , . _,. __. .__ �_. _ _ ,.__ .__ _ a 8l l � \ -v �.^��� .�\ � �_ -- _ � � �� q — � �d38Wf1N llWd3d J�dViINtlS H�13�S �Nd S1N3WW0� 1dN011100d ' -'���`'"'`''�, PRIVATE ONSITE WASTE TREATMENT county ���o$P �'"�'+� SYSTEMS Sawyer ��' ( POWTS) �� s ,�, ��`�� � i.� �A�`�r<r�,��.,��,P`/ ' <<-- INSPECTION REPORT sanitary Permit rvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � O - �� � Personal infonnation you provide may be used for sccondary purposes[Privacy I�w,s. 15.04(l)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#: S os w„� L.-.1.� �.,,,a-�� 'Pw� —0 3a�op 3► ��L insp BM Elev: BM escription: � � Parcel Tax No: (����' wl � N< < ;h �f'' wl�� �,� =t(1�� o�����-oo ,00�a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �3 � 7), Y � Dosing u ��(o � i-{?�' 6q•35� Aeration Bldg. Sewer (��,8' Holding St/Ht Inlet ?� 6,$�'' „2 � TANK SETBACK INFORMATION St I Ht Outlet TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet AIRINTAKE Septic NA Dt Bottom �p,$S ` (� ,2� Dosing NA �� T ��� ' Gentotr� �' Aeration NA Header/Man. Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM 8 o rte�-}- `f�7S � (,��35� TDH Lift Friction Loss Sys Head TDH Ft Q �,(�•}-� (o ?S ` (�7,3,S` Forcemain L Dia Dist.To Well i ��q TN ,P'[- 7.0 ' (0'7, I ' DISPERSAL CELL INFORMATION P'f'o�Tfn ���M. `'7.(6 ' 6�. 4Y' DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer: � Conv ❑ Aggregate �.�`' SETBACK P I L Bldg Well OHWM of Nav � IGP p� Chamber INFORMATION Waters o AG ❑ EZFIow Model Number: CELL TO ❑ Mound o Other Qy,� DISTRIBUTION SYSTEM X Pressure Systems Only --- - - fHeader/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac Spacing ❑Yes ❑ No I___-- - -- -�---- __- -- __ - -- — --- SOIL COVER � Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center Cell Edges � Topsoil ❑Yes ❑ No 0 Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) _� V� �K Yl p� �o� � ` Plan revision required?�Yes❑ No �j y �� �2 ��- � 1 --- � �c��(� Gv _ Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) _ ADOITIONAL COMMENTS ANO SKETCH SANIT,4RY PERMIT NUMBER: � C5� � — � �— — (A � � _ � . �� I � � i�g i ,, � �- j b��9� 1�� ( ' s-r��j . _;_ , _ _; i � ;�5� `��� ����s� ( — — — � i . "'���plb�'• l'�. ' ` � � i �$,�3 ; � y,, � �o Nh•�'$ sT��P j 3 , � _ _ _�,���; _ / �. �- - 3� - - - � �+ � � � � �, � � .� �� ��� �°�� � � �� \s.�s� \• � � �� --P�--- ssn�� i°—�_ '"��''"-'-''"��; PRIVATE ONSITE WASTE TREATMENT �ounty �';�$P `�`�'_�'�, SYSTEMS S awyer `�;��� s %1y' ( POWTS) �='-�'�^�%� INSPECTION REPORT sanitary Permit No: ' Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �O - �� � Personal infonnation you provide may bc used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Hoider's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#: S�S �w„� L.L� }{��}W- Pwi3-0 320003l�-c— Insp BM Elev: BM escription: Parcel Tax No: loa.a� �ra;( ►,� �,��, w�,�� �;� o i 2�� t-oo - (3�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark -2,p ' q�.o' (QO,o� Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation • Contour Aeration NA HeaderlMan. 6:0� `j2,o' Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface 7-o r `�l �r Manufacturer Demand Final Grade Model Number GPM K� �t^i�. S.a � �3.�� TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W 3 � L �-�2 -7a; •��' #of Cells 3 Type of System Distribution Media Manufacturer. SETBACK OHWM of Nav 4� Conv ❑ Aggregate '� I INFORMATION P I L Bldg Weil Waters °� GP qc Chamber Model Number: o EZFIow CELL TO +�S -�l�a` tl oo -i-(� ❑ Mound o Other ��,� DISTRIBUTION SYSTEM X Pressure Systems Only - - - -- Header/Manifold Distribution Pi e s X Hole Size X Hole Observation Pi es P � ) P Length Oia Length _ Dia__ Spac i Spacing ❑Yes ❑ No --- _ -- _ _.. SOIL COVER -- - -- --- - - � Depth Over Depth Over Depth of Seeded/Sodtled Mulched Cell Center �Ceil Edges Topsoil _ _ ❑Yes ❑ ❑Yes ❑ No COMMENTS: (Inclutle code discrepancies,persons present,etc.) �� 3 �� `� S� � ,S . � Plan revision required?❑Yes ❑ No DY ��{�� f -- ` � �9 5�,(� �— Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) , AOOITI�NAL COMMENTS ANO SKETCH SANITARY PEAMIT NlJMBER: �Ol �.2.� C Y3� / . . , -- ,, _ CK3� ,p CY3� a , . _ 1 �' , _: . : ; __ __ �� _. QY x s� • • '. 5�' � '�`f' , � a • �'�J � ,�, � �,,n���^�r �� �, ���� � S� - �127-�.i i l w � ,, , r �+ , _ w�, ... 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