HomeMy WebLinkAbout032-540-30-3209-SAN-2022-047 ��^Y`"� Industry Serviccs Division �o�tY -
= - 4822 Madison Yards Way ,sQ��,��
,-,l`_�s P - Madison,WI 53705 Sanitary Permit Number(to be fillcci in by Co.) �
� = P.O. Box 7162
�k;;;� Madison,Wt 53707-7162 �3 G10�3 �
Sanitary Permit Application State Transaction Number p
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to thc appropriate govemmental unit
is reyuired prior to obtaining a sanitary permit.Note:Application forms for state�wned POWTS aze submitted to Project Address(if dif£erent than mailing addretis) �
the DcpaRmcnt of Safcty and Professional Scrviccs.Personal information you providc may be used for secondary
pucposcs iu accordancc with thc Privacy Law,s. 15.04(l)(�n),Stats.
L Application Information-Please Print AlLlnformation 7.�q,s �� y ,��Q,�
Property Owner's Name Parcel#
f!'e r�cK .{ ritt%da ; o •�3 o3a v
Property Owner's Mailing Address Property Location
�S JNfiY R d 7 Govt.Lot
City,Statc Zip Code Yhone Number
� �' / /NA/• Jr
N� '/a, ,S� %<, Section_�
II.Type of Building(check all khat apply) � � L�t n T � N R .3 E o
�l or 2 Pamily Dwellin�-Nu�nber ofE3edrooms � Subdivision Name
Block#
❑I'ublic/Commercial-Describe Use
❑City of
�State Owned-Descabe Use CSM Number illage of
QT�>w,�<,e 1.✓�,vTr/' '
IIL Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on liue A.�Check one box on line B.Complete line C if
a licablc.)
n New S stem Re lacement S stem ther Modification to Exislin�S Stem ex ]ain Adciitional Pretreatment Unit c x lain
� Y � P Y � b Y' � P ) ❑ (' P )
�' �Holding Tank ❑In-Ground ❑At-Grade �Mound Individual Site Desig� Other'Type(explain)
(conventional)
ist Prcvious Permit Number and Date Issucd
C• ❑Renewal Before �Revision �Change of Plumber �Pransferto New Owner —
F,xpiration
IV.DispersaUTreatmeut Area and Tank Informa[ion:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Reyuired(s� Dispersal Area Proposed(s� System Elevation
Oo �v �vA .v�l �//�
Capacity in Total #ol� Manufacturer
'I ank InfoRnation Gallons Gallons Units � U U „ �
New Tanks 6xisting Tanks � o ^ � Y � � �
G. U v� � cn w C7 C.
Septic o jolAing'I'ank �av � ��oV �
�iCa r�/
Dosing Chambcr � � �
V.Responsibility Statement- I,the undersigned,assume responsibility for instdllation of the POWTS shown oo the aflac6ed plans.
Plumbcr's Namc(Print) Plumber's Signahire MPRS Number Business Phone Number
Ruc �ST�e.✓a�t ��olr � 7�s-9yJ-�?s�r.Z
Plumbcr's Address(Street,City,Statc,Zip Codc)
/y�y� ,sr �w y vo �.�i .�d, wx yb3.s
VI.Co nty/llepartment Use Only
� Permit Fee Date Issued issuing Agent Signature
�Ap c • ❑Disapprovcd $ `'0D p9
❑Owner Given Reason for Denial ' ��l�-01�.-
Conditions of Approval/Reasons for Disapproval �;l['�"
_ ,� .�.: . o �G��1 '�;���
� ��
�� �� ' 4 APR 0 8 2022
�
SfaE�/Y�t� �'�`'_;iJTY
-�i;l,v�i`:�,i:�,.:.°i1;1:�iJ�i'1�:1�(71�i
Attach to complete plans for the system and submit to the County only oo paper not less than S 12 i 11 inches in size
NO REFUNDS AFTER
sBD-�39s�R.o3i2i> ISSUE OF PERMIT
Sawyer County Zoning & Conservation Administration
��������� ]0610 Main Street,Suite 49 �
� 1� Hayward,Wisconsin 54843
' ��� �� l�� (715)634 828A
�• ,� FAX(715)638 3277
/ ,��_�� / i,,.;� c.'.: i u�.
� �i
/
I � �•'�"��' i E-mail: �un � � �:_���2 c�in �ry
� � � Toli Free Courthouse/General Informat�on 1 877-699-4110
,� �
f1��\������
Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp ��{ l b� l oZoZ
ParcellD# 0 3 ,?- S' Y o _3 0 _ 3 � o �
II. Plot Plan
�Property Lines _�Bench�nark BM ♦
Site Address _�North Arrow
�Structure XScale
�Well �j <25' to Service Road
�D Legal Description �Nearest Road Intersection
�Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans
� Index Page with Original Signature
�C Management Plan/Contingency Plan
� Servicing Contract
�Holding Tank Agreement form
IV. Holding Tank Specifications
�Cross-section— Manufacture, Gallons: S� a,�fl
�Tank Anchor Calculations [SPS 383.43 8) g)]
�Locking device, chains/locks
1�Alann and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and
State Statutes 101.862(2) and ]01.862(3)
J�3" Bedding Material < 1/2 "
V. Holding Tank Plans per Co�nponent POWTS Manual
P�Version 2 SBD-]0855-P (R.3/07) �.,
Owner: ✓�'��S Plumber: �� �
Application Review Date: �`� �� 8 I �.Z
POWTS Reviewer: ���
Namc
�j� � I�o
Liccnsc#
Revised 4/1 V2013
CONCRETE HOLDING TANK DESIGN
Singte Tank Optron
INDEX AND TITLE SHEET
Project Briggs Holding Tank
Owner Frederick& Kristina Briggs
Address 32252 County RD 72
Miliviile, MN. 55957
Legal Description Prt NW-SW-S.30-T40N-R.SW
Township Winter County Sawyer
Subdivision Name Lot No.
Parcel ID Number 32540303209
Plan Transaction ID Number
Index and title sheet Page 1
Holding tank specifications Page 2
Site plan Page 3
Maintenance and contingency plan Page 4
Tank Drawing Page 5
Powts Maintenance Agreement Page 6
Holding Tank Servicing Contract Page 7
Designer Bruce Vitcenda
Signature /�y,�� Phone No. 715-943-2382
License Number M.P. 220498 Date 03/28/22
Designed pursuant to:
Holding Tank Component Manual For POWTS(Version 2.0)
SBD-10855-P(N.03/07) , , ,
version 7.0(03/12) Page 1 of 7
HOLDING TANK SPECIFICATIONS �
2 Number of bedrooms
Non-residentiai estimated flow(gpd)
2000.0 Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity(gal)
kaw Tank Manufacturer
2000 Holding Tank model number
SJE Rhombus Alarm manufacturer
01-H Alarm model number
Tank Dimensions and Data Tank Ancho�Calculations
X for round tank 16100 Ibs Weight of tank and cover
49.0 Liquid depth below inlet invert(in) 1.10 Safety factor
6.0 Maximum de th of soil cover(ft) 11691 Ibs Weight of anchor required
59.0 Height(in) Outside 17.0 in Soil cover req. for anchor or
154.0 Length (in) Dimensions 2.9 yd� Concrete counter weight
77.0 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished ��ent cap
junction � warning label grade
box —� �
�4"min. 12"min. —
E—23 in. �
Manhole and vent locations
conduit --� vent pipe
18"min.
� tether weight -
12.0 In. building sewer
� O service � inlet
blind plug alarm on Note. All tank joints, and
to seal joints between tank
out�et openings and piping are
Electrical as per 37.0 in. sealed watertight. All
NEC 300 pipe and vent materials
and SPS 316 comply with SPS 384.
3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project: Briggs Holding Tank
Transaction Number: Page 2 of 7
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HOLDING TANK MANAGEMENT PLAN "
This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and
maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P
Pl. 03/07), and the Sawyer County Sanitary Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 40.0 to 400.0 gpd.
2. The owner of this POWTS is responsible for system ope�ation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90%of the tank(s)capacity or a level of 12" below the inlet
(at which time the alarm will activate), the pumper listed in the current Service Contract must be called to
empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers and
manhole cover(s)and verify that the alarm system functions and manhole tocking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions
shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 30 days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes
a failing POWTS and may result in issuance of correction orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards
for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue
of a person ftom the interior of the tank may be difficult or impossible.
8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank
may be installed in the same location (a new sanitary permit is required for such a replacement). Con-
nection to municipal services would also be considered at this time if they are deemed availabte to the
property.
9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with SPS 383.33 Wis. Adm. Code.
10. If there is a problem with, or question about this installation, the following persons may be contacted:
a. Installer......................... A-1 Plumbing Phone: 715-943-2382
b. Service Provider............... Northwest Sanitary Phone: 715-943-2650
c. Co. Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288
11.
Project: Briggs Holding Tank
Transaction Number: Page 4 017
1NLET
67.00
71.00
77.00
.'� ��.
i \� WARNING DEATH MAY OCCUR IF TANK IS ENTERED
� Q � WITHOUT PROPER EQUIPMENT 154.00
1 � � � �
� � NOTE:SEE/NNER WALL PHOTO ON THE"EXCLUSIVELY AT SKAW S"PAGE. 148.00
� � II
.� �;
144.00
TOP VIEW OF MANHOLE COVER NOTE:WHEN THE OUTLET IS PLUGGED THE LIQUID
DEPTH IS INCREASED TO 49 INCHES.
�
4.00
-J- 4"PVC SCHEDULE 40 COUPLING(VENT)
\
5 00 ' ' —�- TOP V1EW OF TANK (TAPERED)
� �--�s.00--� �.00�
INL� �z.°° n
G ; s�W z� ;
� �
`--- 69.50
4 INCH PRESS i i
SEAL GASKET � � i i
INSTALLED i I
WHEN POURED � � � �
49.00 � � I I
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I I I I
1 I
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�-------------------------J
s.00 SECTION VIEW OF TANK AND COVER s.00 OUTLET END VIEW OF TANK
Model Number: Z000 HOLD/NG gKqVi► pRE-CAST Phone: (715) 967-2277
Approved for. HOLDING
Weight n e ►m. Outlet Dim. �q• ep Gal./In. ax. ap. 26255 105th Street, New Auburn Toll Free: 1-800-924,-8625
Wisconsin 54757 Fax: (715) 967-2707
16,100 Ibs. 52„ N/A 49�� 44.19 2�65 gal. www.skawprecast.com
.
HOLDING TANK SERVICI\C C(�N"I'RAC'T
Contract Date: �/ �9 / .�z
This contract is made behveen the Holding Tank O���ner and the Pumper.
Holdin�Tank Owncr's Name: Pumper's Name:
Northwest Sanitary, Inc.
PO BOX 155
F/'ea �c Radisson,WI 54867
Parcel Identification Number:
( 12 Di�it Lcgacy ID) 0 ��-,� y o - 3 0 - 3 � m �
�. T�1L'(?\i�SiC�3��1'�_'L'c ir3 tt�C? �_l!��l (lf t{1!S CO!?1C8Ct �VlI�1 �}lE'�n�'C'T(!?llf,'[113� �t]ii. SA�S'VCl"�(?tlllfV.
which has acccptcd and recordcd with thc Officc of thc Rcgistcr of Decds, thc Maintcnancc
Agrecmcnt for a Holding Tank required under the Sa���ycr County Privatc Se�vage System
Urdinance for the issuance of a Sanitary Pcrmit for the inst<illation of�� holding tank(s).
2. Thc o�vner agrccs to have thc holding tank(s) serviced by thc pumper and guarantecs to
permit the pumper ro have access and to cnter upon thc property for the purpose of servicin�
the holding tank(s). The owner agrccs to maintain the all-wcather acccss mad or drivc,o
that thc rumper can scrvicc thc holding tank(s)w�ith thc pumping cquipmcnt. Thc owncr
furChcr sgrccs to pay thc pumper for a chargcs incurrcd in scrvicing thc holding tank{s)as
mutually agrccd upon by thc owncr and pumper.
3. Thc pumper a��recs to submit to the Govcmmental Unit, Sawyer Counly, a repori ior th�
seiti icing of the holding tank(s)as required under SPS 3K3.55, Wisconsin Administrative
Codc and thc Sawyer County Privatc Scwage System Ordinance. �'he pumper further
a�rccs to irn:ludc thc following in the rcport:
a. The name and addnss of the person responsible for sen icing thc holdinL tank;
b. T'hc namc of thc owner of thc holdin�cank;
c. The site address of the hulding tank;
d. "I'he datc the holdin�tank was serviced;
c. The �olumes in �allons of the contents pumped from the holdin�tank for cach scr-vicinL:
l�. Tl�c disposal sitcs to which thc contcnts from thc holding tank wcrc delivcr�d.
4. This agreement«�ill remain in ef�fect until the owner or pumper terminates this contract. [n
the event of a change in this contract,the owner agrees to file a copy of any changes to this
sei-�ice co��tract or a copy of a new service contract with Sa�vyer County�vithin ten (10)
business days from the date of change to this service contract.
O��'T1C1'',Name: (Print) n��'ill'C'ti SI�.,TII'dIUI'(:: (()nh nneoNnersignaturerequired�
F� 1 �," � ��
Ptn��per'� Name: (('rint) Pumper's Signature: �
Ronald L Vieceli, owner Northwest Sanitary,lnc , � �
Pum�cr's Rc�istration Numbcr:
#2389
Rc�.03:2fi 13
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- USE BLACK INK ONLY- ;{;4G:�jZg;�
POWTS MAINTENANCE AGREEMENT 438551 �
For Holding Tanks REGISTER O DE DS
Owner's Name(s)as shown on deed: SAWYER COUNTY, WI
04/OS/2022 1I:59 AM
fi't �Ick l./!�,' � ;�a ry1• 3�:
�E�ORDING FEE 30.�0
Parcel Identification Number
(12 Digit Legacy iD) ���- f � O -� O -��0 L ����'�: �
Legal Description of Property
- SEE ATTACHED SHEET-
We acknowledge that application is being made for the installation of a holdiny tank(s)on lhe �
properry described on the attached sheet.
Ret�!m Tn Sawye:CounhfZoning and Co�servaticn:'W��nistra�io:�
10610 Main St.Suite 49, Hayward,WI 54843
As an inducement to the Counry of Sawyer to issue a sanitary permit for a holding tank on the above-described property,the owner is
responsible for the operation and maintenance of the holding tank, locking device,alarm and access,and agrees to conform to all
applicable requirements of SPS 383,Wis.Adm. Code relating to holding tank management, including the following:
1. The owner agrees to r,ontract with a person who is licensed under Ch. NR 1 13,Wis.Adm. Code, except as provided by
Section 281.48 (3j (d), Stats., to have the holding tank properly serviced and to file a copy of the service contract with the
governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service
contract,with the governmental unit within ten(10)business days from the date of change to the service contract.
2. The owner agrees to coniract with a person licensed under Ch. NR 113,Wis.Adm. Code,who shall submit pumping reports to
the governmental unit in accordance with SPS 383.55,Wis.Adm. Code,for the servicing ofithe holding tank. In the case of
exemption under Section 281.48 (3) (d), Stats., the owner shall submit the report to the governmental unit. The governmental
unit may enter upon the property to investigate the condition of the holding tank when pumping reports may indicate the
holding tank is not being properly maintained.
3. If the owner fails to have the holding tank properly serviced in response to orders issued by the govemmental unit4o prevent
or abate a human health hazard as described in Section. 254.59, Stats.,the governmental unit may enter upon ihe property
and service, or cause the tank to be serviced. Pursuant to Section 145.20(4)Wis. Stats.,a governmental unit may assess the
owner of a private sewage system for costs related to the pumping of a septic or holding tank. The charges will be assessed
as prescribed by Section 66.0703, stats. The owner agrees to pay all charges and cost incurred by the governmental unif for
inspection,pumping, hauling,or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate
_ any human health hazard caused byth�trofding�ank.
4. This agreement will remain in effect only until the governmental unit responsible for the regulati�n nf nrivate sew2�ge.sy�ems
certifies that c:ither a soil absorption system that complies with SPS 383,Wis.Adm. Code,or a municipal sewer seruescne
property. In addition, this agreement may be cancelled by executing and recording said cectification with reference to this
agreement in such manner which will permit the existence of the certification to be determimeci byreference to the property.
5. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit
the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which wibl
permit the existenc.e of the agreement to be determinetl by reference to the property whe[e the holding tank is installed.
-Only one owner signature re uired- ACKNU�WL.�DGMENT
O�r's Si natuti!/� State of: �'�i�'Yl��`'��.-
County of: ��"-���-�f'�,t-'�.r
Ow'er's Name (Prin : Subscribed and swom to befgr.e rne on this
� � -- y ( ' • , 20�
t,/�G�r� _ �� c� day of �-'1
Date: � �� -
B Owner's Name): t��i�'�JC� `_�
- ' �v �� Notary Public Signatuce: ��
Drafted by: Public Notary Name (Print)c � \\ ��
�v __1�t'u� 1!�'�'t'2hAq My commission expires ont UI "�' '
>di'!�`�.,� Michelte L Wendt
� y ry p P � y § � �° State of Minnesota
Personal information ou rovide ma be used for seconda ur oses Privac Law, 15 0 �� � Rev. /26ht3
at p, �� Notary Public
��,�1 �;al&3' Commission No.31057158
�`'��" MY Cornmissbn Expires 1I31I2023
_.._�.:_.
Thaf par� of the NW'/4 of the SW'/4 ly�ng South of the town road
right-of-way, Section 30, Township 40 North, Range 5 West, Tovvn of
Winter, Sawyer County, Wisconsin.
Real Estate Sawyer County Property Property Status: Currerrt
Listing
Today's Date: 3/25/2022 Created On: 10/18/2007 12:36:12 PM
Description Updated: 5/3/2021 Ownership Updated: 2/3/2022
__._.__ _.__. .__,._._. ___.______ _..___ . ._ ___ _ --- � _---._ ----- --------
Tax ID: 39578 FREDERICK L & MILLVILLE MN
P�N; 57-032-2-40-05-30-3 02-000- KRISTINA M BRIGGS
000090
Legacy PIN: 032540303209 Billing Address: Mailing Address:
Map ID: .10.9 FREDERICK L & FREDERICK L &
Municipality: (032) TOWN OF WINTER KRISTINA M KRISTINA M
STR: 530 T40N R05W BRIGGS BRIGGS
Description: PRT NWSW, LYING SOUTH OF 32252 COUNTY RD 32252 COUNTY RD
72 72
RD MILLVILLE MN 55957 MILLVILLE MN 55957
Recorded 0.960
Acres: Site Address * indicates Private Road
Lottery _ ____ ___ _--- ---_----____ ____ _ _ _ __ ___ .
Claims: � 7295W HEMLOCK WINTER 54896
First Dollar: No HAVEN RD
Zoning: (RR1) Residential/Recreational property
One Assessment Updated: 6/18/2019
ESN: 421 _ _ _ _ _ __ __ _ __ _ __
2022 Assessment Detail
Tax Districts Updated: 10/18/2007 Code Acres Land Imp.
_.__- ---_---- ----._ ____--- -------.______ ___._____.�. G6-
1 State of Wisconsin pRODUCTIVE 0.960 4,300 0
57 Sawyer County FOREST
032 Town of Winter
576615 Winter School District 2_Year 2021 2022 Change
001700 Technical College Comparison
Land: 4,300 4,300 0.0%
Recorded Improved: 0 0 0.0%
Documents Updated: l0/2/2013 Total: 4,300 4,300 0.0%
. __-_ __._ ___ . __ _.__._ . �_._ _ .__ _. _______ ____---.
WARRANTY DEED
Date 437145
Recorded: 1/17/2022 Property History
QUIT CLAIM DEED -- ___ __ __.. __ ___ . _ _ __._ _ ___.
N/A
Date 416 04
Recorded: 3/7/2019
QUIT CLAIM DEED
Date 415337
Recorded: 11/8/2018
IN REM JUDGMENT
Date 70 4
Recorded: 9/4/2013
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<)ffice of
Sawyer County Zoning and
Conservation Administration J
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10610�1ain Street. Suite 49 ��:f�
Hayward, WI 54843 � � ��/,�,
TcL (7151 63-1-8288 �� �����J
Fa�: (?15)638-3277 S �
URL:http:/�'sawyercountygov.or� �j��1'FR ����
Email: zonin�.sec�sawyercount�ov.or�; ��pM�NlQ����
Toll Free:Courthouse/Ueneral Information wS.. �
1-877-699-41 I 0 �<<C�•
Sawyer County Zoning and Sanitation "As - Built" Form
PropertyOwner'sName flec����cK �/'��_
Fire Number and Road Name _ _7� 93'w_ N���o�h n vt�✓ �_
Plumber's Name �{_- i �u,�,b�'T
Date of Instaliation �t�� '� �
County Sanitary Permit Number _ � �i_�4 y 7_____ __
12 Di��it Parcel Number _ 03,�.5 y0 30,3a0 g _
Description and Elevation of Benchmark �,'�Q,✓ /,ro1/,:✓T T�,�k �f%J« ��l�
Tank Manufacturer and Capacity �{f g�_��pQ� ',d
Setback-Tank to Nearest Lot Line � �
—�--- ——
Setback-Tank to Nearest Well 7S� �
Setback-Tank to Building __ ���___
Cell Width �
Cell Length �
Number of Cells �
Setback-Cell to Nearest Lot Line �
Setback- Cell to Nearest Well �
Setback-Cell to Building �_ _
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 Da�a
Benchmarl�- � .� ' Please include the followin�:
Building Sewer y.oy'
Tank In _ H. �t' � Location of observation and vent pipes
Tank Out � Feet of risers used on tank(s)
Dose Tank In • Location of benchmark and North arr��w
Dose Tank Bottom _ � 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 aiid road
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