HomeMy WebLinkAbout028-742-31-5107-SAN-2022-018 C)fiice of
Sawyer County Zoning and
Conservation Administration
IOfi10 Main Street, Suite 49
Hayward, WI 54843
"Cel: (71�)634-8288
FaY:(715)638-3277
URL:http:%/sa���vercountyQov.or�
Email:zoning.sec ci sawyercountygov.org
7'0l(Free:Courlhouse/General Information
1-877-699-41]0
Savvyer County Zoning and Sanitation "As - Built" Form .
Property Owner's Name �GLV'��0..�,1 � �.1-�G� l�l f1 S���-
Fire Number and Road Name o 2oo—t w D;e�.'S`) ��
Plumber's Name I '�^'�`S �"`� " `` ��
Date of Installation � � � � `��
County Sanitary Permit Number S(q!J 2�' d� D
12 Digit Parcel Number �Z��-1 Z � �7' � J �C7�
Description and Elevation of Benchmark _�``� `� _�� "U��
7'ank Manufacturer and Capacity �U� (�u � L� �'��.1` __
Setback-Tank to Nearest Lot Line l�t� �
,�- I
Setback-Tank to Nearest Well � 5
Setback-Tank to Building _ �� t __
Cell Width
3 �
Cel1 Length _ _��
Number of Cells �
Setback-Cell to Nearest Lot Line �� �
Setback-Cell to Nearest Well 7� �
Setback-Cell to Building __�S �
l'�° �
Setback- Cell to Navigable Water _ _ •
_�
Make and Model of Dispersal Unit _ _
Make and Model of Filter �� ���j ��°� ' �� �
_ ! ���'��� �`�����'i
Make and Model of Pum _ �1�
p - J U N 1 4 2 0 2 2
SAWYER CQt.aP��"�"Y
ZOIVING ADMiN1Sl"�tH�i�7N
- Please complete other side -
"As-Built Plot Plan"
Elevation Data
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Benchmark S+ � Please include the followin�:
Building Sewet• �
Tank In �j� � Location of observation and vent pipes
Tank Out (l � 3�� � Feet of risers used on tank(s)
Dose Tank In � Location of benchmark and North arrow
. Dose Tank Bottom � Location of all components
� Header or Manifold !3��" � Length of pipe between components
. Distribution Pipe � Number of chamber units in each cell
System Elevation ly� �?` � Location of well, lot lines and road
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