HomeMy WebLinkAbout012-739-06-5302-SAN-2021-370 �
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OfFice of
Sawyer County Zoning Administratio D 'i (` �� �! � �,-�
PO Box 676 n � ..,t_����i�, t_:���
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Hayward, WI 54843 �`�L:� p�� � � Z��� �'
Tel:(715)634-8288 ! �
Fax:(715)638-3277 � :- . ---
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URL:http://sawvercouniv o�v.org �.: �„,u�.:,, ,;,,;,.;t�;,;;;;-`:,-;,,
Email:zoning.sec�a sawvercounty og v_org '�- �
Toll Free:Courthouse/General Information
1-877�9911110
Sawyer County Zoning and Sanitation "As - Built" Form
Property Owner's Name .f�S 4.✓ �0�h 8 f
Fire Number and Road Name �,� l 7�l �/ C 0.✓c e� �d
Plumber's Name ��U[P v Z%Fr.✓d�
Date of Installadon q' � �' � �
County Sanitary Permit Number � ( '� 7 (�
12 Digit Parcel Number U l:� 7 3 qd 6�'.�a�
DescripUon and Elevation of Benchmark /v0.f� ' N�I/��.✓ L,'cti f Po/e
Tank Mam�fa�t�irPr an�Cararitv �� � /� 0O�7,s0
Setback-Tank to Nearest Lot Line 7 �
Setback-Tank to Nearest Well ,�0� �
Setback-Tank to Building �/ 9 �
Cell Width .v�
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Cell Length
Number of Cells �
Setback-Cell to Nearest Lot Line "
Setback-Cell to Nearest Well �
Setback-Cell to Building f
Setback-Cell to Navigable Water
Make and Model of Dispersal Unit
Make and Model of Filter
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Make and Model of Pump _
- Please complete other side -
� "As-Built Plot Plan"
Elevation Data
Benchmark �ao.a' Please include the followin�:
BuildingSewer ��. �
Tank In 13.S' •Location of observation and vent pipes
Tank Out 93.d S •Feet of risers used on tank(s)
Dose Tank In •Location of benchmark and North arrow
Dose Tank Bottom fr 9.�Y-�S�o�lt •Location of all components
Header or Manifold -- •Length of pipe between components
Distribution Pipe — •Number of chamber units in each cell �
System Elevation •Location of well,lot lines and road
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�/.:�`-'`'�'-`""`'�:;r PRIVATE ONSITE WASTE TREATMENT county
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�� ,��o$ ����,. sYsrEMs Sawyer
��"�� P$ �i ( POWTS)
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\k�rss'"-V�''' INSPECTION REPORT sanitary Permit rvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � � r �7�
Personal infonnation you provide may be used for secondary putposes [ Privacy Law, s. 15.04 (1)(m) ]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�-�s4�, L � `�Msfi �t�, �i3—co� �o�--�rs- �
Insp BM Elev: BM Description: � N� ( �� P� =5� Parcel Tax No:
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TANK INFOR ATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI ELEV
Septic �jk�/— ��pp Benchmark 00,0�
Dosing ��.•.� 7$D
Aeration Bldg. Sewer 9y', `
Holding St / Ht Inlet q3, '
TANK SETBACK INFORMATION St / Ht Outlet q , ��
TANK TO P/L WELL BLDG vEr,rro ROAD Dt Inlet
AIR INTAKE
Septic �` ' ` ��� NA DtBottom �3�95 �
Dosing r N �, p N,q Installation �� Y �
Contour
Aeration NA Header / Man. q$.S"$'�
Holding Dist. Pipe
PUMP / 51PHON INFORMATION Infiltrative ���q r
Surface
Manufacturer �j— Demantl Final Grade
Model Number �� GPM
TDH � S Lift Friction Loss Sys Head TDH Ft
Forcemain L d�,2�(p Dia << Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N �` L �p� # of Celis Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv � Aggregate
INFORMATION P I L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO � a�� .{..��a .a-�a a ' � Mound o Other
— — --- - ---- - -
DISTRIBUTION SYSTEM X Pressure Systems Oniy
— -- -- ------
Header/ Manif�id ,, Distribution Pi e(s) �, � X Hole Size X Hole , Observation Pipes
Length � Dia o�,o Length �`Y�9 � Dia � �S Spac _3�� 0� �S6 �� Spacing'?°� Yes ❑ No �
-- -- -- -- - --- � ---—
SOIL COVER
— - - _-- — - _ _ - ---
Depth Over �r Depth Over �� 1 Depth of �� Seeded / Sodded Mulched
Cell Center [� � Cell Edges ��2 I Topsoil _�___ Yes ❑ No Yes ❑ No�
COMMENTS: (Include code discrepancies, persons present, etc.)
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,�o� _ c.� _ � I �7 �a.2
Plan revision required?� Yes � No �� '� �3 L -- L�� ( �
— - - v �
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710 (R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: v�I-37 a
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