HomeMy WebLinkAbout012-740-36-2103-SAN-2022-082 �/;
� Industry Services Division County �� �
- 4822 Madison Yards Way �� �
; ,�_ - Madison,WI 53705 Sanitary Permit Number(to be filled in by Co.)
' P: . ' P.O.Box 7162 k�
;.cr;,•:�..
Madison,WI 53707-7162 �3� ��� �
Sanitary Permit Application S�`e Trd"�```°°N°"'be` '
In acwrdance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit P�res-- osa a oo�� "� �
is required prior to obtaining a sanitary permit.Note:Application forms for stateowned POWTS aze submitted to Project Address(if different than mailing addres �
the Depaztment of Safety a�d Professional Services.Personal information you pmvidc may be usecl for secondary
pucposes in accordance with thc Privacy Law,s.15.04(L)(m),Stats. /
I.Application Information-Please Print All Information �(O �N � ��
Property Owner's Name Parcel#
a �le d- �1 ��.�ie ��n� }.�c..e �y C�`�Po.�oDQ� � �0 3� a�0 3
Property Owner's ailing Address Property Location
�C� 5 P ,SS 1-rt. . q��t'
City,State Zip Code Phone Number �I 2
� w C�/�- "�
SL[O� � 7 j�_�o ` �P ('t Y<, '�_%a, Section J�
II.Type of Building(check all that apply) Lot# T �' � N R ( E or w
�1 or2 FamilyDwelling-NumberofBedrooms "/ — SubdivisionName
^ Block#
� �Public/Commercial-Describe Use ^
� ❑City of
�State Owned-Describe Use CSM Number illage of _
� �Town of ��/C�1�
III.Type of POW1'S Permit:(Check either`�New"or"Replacement"and other appHcable on line A. Check one bog on line B.Compiete line C if
a licabie.
A' �Tew System nReplacement System ❑Other Modification to Existing System(explain) ❑Additional Pretreatment Unit(explain)
L.J
B' ❑Holding Tank ❑In-Ground �At-Grade Mound Individual Site Design Other Type(explain)
(conventional)
C• ❑Renewai Before �Revision hange of Plumber �I'ransfer to New Owner �st Previous Pemiit Number and Date Issucd
Expiration
IV.DispersaU'Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
�oCO �� � � � �0 1 l.3�
Co�� Capacity in Total #of Manufacturer Y
Tank[nformation Gallons Gallons Units � U U '� � . ;
1��v/��� New Tanks Existing Tanlcs y a y � � p � �
0
a U m � ri� iz. C7 ci.
Septic or Nolding Tank / )�S� j�
EoC l7
Dosing Chambcr / ?� ��, � �
V.Responsibility Statement-I,the undersigned,assume responsibility for installadon of t6e POWTS shown on t6e attached plans.
Plumber's Name(Print) Plumb Signature � � MP/MPRS Number Business Phone Number
r�� � ��aM .� �a��c� ��s-�6-�g��a
Plumber's Ad s(Street,City,State,Zip Code)
Sv --� �'ha /2� ���� G�. s`l�`Z�
VI.Co u /Department Use Only
�A p � ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�/ dD ,q
❑Owner Given Reason for Denial $ `��+ ', I 3 � �`� ��-u'L-�`f�^
Conditions of ApprovaUReasons for Disappmval � ����
�J �� ���,.�? �'4`f �--1,��
�;t 4 �-% � �
.� csT a�- ��.� MAY � s zozz ���
Y �� � ��
saw��ER cc�v��-��
ZOIdING ADMWlST�iATtON
Attach to compkte plans for the system aod submit to t6e County only on paper not less than 8 U2 x ll inches io size
SBD-6398(R.03/2l) NO REFUNDS AFTER
ISSUE OF PERMtI'
,.��'""��e�� DIV1310N OF INDUSTRY 3ERVICE3
10541 N RANCH RO
p NAYWARD WI 54843-8482
_ � Contact Through Relay
��..� P S ' httpl/daps.wn.pov/programNinduatry-aerviceo
'!. www.w�u�nS�n qov
�''�'.,e�.,,.t�.
Tony Ewn-Oov�rnor
Dawn Crim-S�cntary
May 26,2022
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES:2024-5-26
Plan Review: PWTS-052200983-C
Craig Thompson
5089N Thompson Rd
Winter,WI
SITE:
Big Chip
7688N CTH CC
Hunter Township
Sawyer County
NE%NW%S36 T40N R7W
FOR:
Description: 4 bedroom 600 GPD—24"to Mound Component Manual—Ver. 2.0,SBD-
limiting factor-Effluent Filter-Maintenance 10691-P(N.01/01, R 10/12)
required. Pressure Distribution Component Manua)—Ver.
2.0,SBD-10706-P(N.01/01, R. 10/12) �
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes.The submittal has been CONDITIONALLY APPROVED.This
system is to be constructed and located in accordance with the enclosed approved plans and with any
component manual(s)referenced above.The owner,as defined in chapter 101.01(10),Wisconsin
Statutes,is responsible for compliance with all code requirements.
No person may engage in or work at plumbi�g in the state unless licensed to do so by the Department per
s.145.06,stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• The site shall be properly prepared prior to plowing.Any grasses longer than 6"shal�be cut short
and removed.To avoid matting,any leaves or loose organic matter shall be raked up and removed.
Cut trees and shrubs flush to the ground and leave stumps.Avoid operating equipment on the
Mound site.If necessary,use only tracked equipment,during dry conditions,with minimal passes,
to avoid compaction.
• Components and soil removed from an existing drain Feld shall be properly disposed of so that
there is no risk to public or environmental health.
• A sanitary permit must be obtained from the county where this project is located in accordance with
the requirements of Sec.145.19,Wis.Stats.
• Inspection of the private sewage system installation is required.Arrangements for inspection shall be
made with the designated county official in accordance with the provisions of Sec.145.20(2)(d),Wis.
Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of
the tank explaining that periodic cleaning of the filter is required.
• A copV of the approved plans,specifications and this letter shall be on-site durin�construction and
open to inspection bv authorized representatives of the Department,which mav include local
inspectors.
Owner Responsibilities
• The current owner,and each subsequent owner,shall receive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manual(s)and be responsible for
ensuring that POWTS is operated and maintained in accordance with this chapter and the approved
management plan under s.SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a
health hazard,the property owner must follow the contingency plan as described in the approved
plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s)utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or
additions should conditions arise making them necessary for code compliance.As per state stats
101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe
building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the
owner and any others who are responsible for the installation,operation or maintenance of the POWTS.
Sincerely,
,l r�o�vZE�
Joshua Rowley
POWTS Plan Reviewer, Division of Industry Services
(715)813-9111
Joshua.rowleV@wisconsin.gov
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Big Chip Outdoors LLC Conditionally
Owners Name: Bradley&Michele Donaghue DEPT.OF SAFETY AND PROFESSIONAL
sE:eW6t�
DIVISION OF INDU£�TRY SERVICES
Owner's Address: 10218N Stress Ln
Hayward Wi 54843 %`'�""�
s�� c:o�kE.sFo�oENc�
Legal Description� NENW S-36 T�0-N R-7-W
Township� Hunter
County: Sawyer
Subdivision Name:
Lot Number: Bl�k Number.
Parcel I.D. Number. 012 740 36 2103
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance speciflcations
Page 6 Management and contingency plan
Page 7 Pump curve and specifications
Page 8 Plot Plan
Page 9 Soil Evaluation Report
Designer Craig Thompson License Number: 220810
Date: 05/06/ Phone Number. 715-661-1278
Signature:
IDesigned Pursuarrt to the
� Mound Component Manual fw POWTS Version 2.0 SBD-10891-P(N.01/01,R. 10/12),and both
� SSWMP Publica6on 9.6 Oesign of Pressure Distribution Networks for ST-SAS(01/81)and
Pressure Distribution Component Manual Ver.2.�SBD-10706-P(N.01/01,R. 10/12)
Version 7.0(R. 11/12) Page 1 of 9
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
,___._
(R or C) ' R Residential or Commercial Design Note: Sand fill(D)caiculations assume a
400.40 Estimated Wastewater Flow(gpd) Table 383-44-3 in-sdu soil treatmeM for
__. . fecai oolihxm of<=36 inches.
1.50 Peaking Factor(e.g. 1.5= 150%)
600.00 Design Flow(gpd)
0.00 Site Siope(%)
98.34; Contour Line Elevation(ft)
24.00 Depth to Limiting Factor(in)
,_, 0^60 M-situ Soil Application Rate(gpd/ft�)
Distribution Cell Information
85.00� Dispersal Cell Length Along Contour(ft) = 7.06 Cell Width(ft)
1.00 Dispersal Cell Design Loading Rate(gpd/ft�)
1 Influent Wastewater Quality(1 or 2) Are the laterals the highest int
y �� in the distributian �Y�
Pressure Disribution Information networfc? Enter Y or N
(C or E) E; Center or End Manifold
3.53 Lateral Spacing(ft) If N above,enter the elevation ft)
Z Number of Laterals of the highest point.
0.125 Orifice Diameter(in)
2.00 Estimated Orifice Spacing(ft)= 7.14 ft/orifice
2.00 Forcemain Diameter(in)
35.00 Forcemain length(ft) Does the forcemain drain back? �
91.00� Pump Tank Elevation(ft) Enter Y or N
6.50 System Head(ft)x 1.3 5-71 Forcemain Drainback(gal)
8.09 Vertical Lift(ft) 76.74 5x Void Volume(gal)
0.88 Friction Loss(ft) 82.45 Minimum Dose Volume(gal)
In-line Fifter Loss(ft) 34.60 System Demand(gpm)
15.47 Total Dynamic Head(ft)
Lateral Diameter Selection Manifold Diameter Selection
in.dia. o tions choice in. dia. o tions choice
0.75 1.25 x
1.00 1.50 x x
1.25 2.00
1.50 x x 3.00
2.00 x
3.00 x
Gallons/Inch Calculator(optional)
Treatment Tank Information ' Total Tank Capacity(gal)
1250.00 Se tic Tank Capaciry(gal) Total Working Liquid Depth(in)
Skaw Pre Cast Manufacturer gaUn(enter result in cell B49)
Dose Tank InfoRnatlon Efflue�t Filter Information
--_ __-_____-
,�_750.00 Dose Tank Capacity(gal) Best _�Filter Manufacturer
_._�._�
16.05 Dose Tank Volume(gal/in) GF 10-8 �Filter Model Number
�,.___.--------__._�,
_____
;Skaw Pre Cast ;Manufacturer
Project: Big Chip Outdoors LLC Page 2 of 9
Mound Pian and Cross Section Views
—1
1/10 B [� J
�� Observation Pipe _•I
K I
O., �s A
W � � —
• g
� .
. . . . . I
I � � �
IMound ComponeM Dimensions
A 7.06 ft E 12.00 in H 1.00 ft K 8.38 ft
B 85.00 ft F 9.50 in I 6.88 ft L 101.75 ft
D 12.00 in G 0.50 ft J 6.88 ft W 20.81 ft
600.10 (ft2)Dispersai Cell Area 1768.85 (ft�)Basal Area Available
7.06 (gpolft)Linear Loading Rate 8.50 (ft)1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 101.13 (ft) —�
...... :,;;.;;;:�;� : :.. . .... � I "
.,
F / Dispersal Cell / 99.84 (ft)Lateral
99.34 (ft)—i�— Invert
Dispersal CeU �3]
Elevation � �
� `
a �` : : ; �. ° :
98.34 (ft)Contour Elevation
0.0 %Site Slope
Geotextile Fabric Cover
Shading Key � $ �— Dispersal Cell See lateral details on
10_ Topsoil Cap �a 1.5 ft � Page 4 for number,size,
20 � Subsoil Cap p� 1 � � � and spaang of laterals.
� ASTM C33 Sand .—"a Z � F Laterals are e quall y
� 0 Tilled Layer � m 0 5 ft Twical�aterai spaced from the
distribution cell's
Q 0 A g gr e gate v o � � � cen terline in t he
�---A—♦� distribution cell(Ax8).
Project: Big Chip Outdoors lLC Page 3 of 9
End Connection Laterai Layout Diagram
MPfSSCPDIffP overt e b �mmswn •=Turn-upwtbsllvalveoraleanoutplug
� p .i
Rtl IatNals are i4entioN �E X--�� Mol es dri�ed on tMe bottom of tM IueraM
equap�spaced S
Faev main oon�etion via tee or cross to manifold x anv point.
Lakerais&forcemain Sch 40 PVC per SPS Table�4 30-G
Number of Laterais 2 Orifice Diameter 0.125 in
Laterai Diameter 1_50 in Orifice Spacing(X) 2.04 ft
Lateral Length(P) 83.64 ft Orifices per Lateral 42
Lateral Spacing(S) 3.53 ft Orifice Density 7.14 ft2lorifice
Lateral Flow Rate 17.30 gpm Manifold Length 3.53 ft
System Flow Rate 34.60 gpm Manifold Diameter 1.50 in
Total Dynamic Head 15.47 ft Forcemain Velocity 3.53 ffi/sec
Dose Tank Information Lockingcoverwithwaming
/''� label and locking device and
/ sealed watertight
i
Electrical as per NEC 300 and —> —
SPS 316.300 WAC �4 in.min.
Disconned _�_
�
Tank component is properfy verned � Altemate outlet
location
ForCemain diameter
Skaw Pre Cast Manufacturer �_ 2 in.
Ca aci 750.00 Gallons
Volume 16.05 gaUinch A
Weep hole or anti-
Dimension Inches Gallons B si�non devtce
A 30.59 491.00
B 2.00 32.10 C '� PumP off elevation(ft)
C 5.14 82.45 � 91.75
D 9.00 144.45 p
Total 46.73 750.00
�tank elevation(ft)
3"Bedding un er tank. 91.00
Alarm Manuafacturer SJS Rombus Note Switches
Alarm Model Number 101 �— containing mercury
may not be used in
Pump Manufacturer Goutds � this system.
Pump Model Number PE 41_ ________r.T
Pump Must Deliver 34.60 gpm at 15.47 ft TDH
Project: Big Chip Outdoors LLC Page 4 of 9
Mound Svsbem Maintenance and Oaeration Specifications
--------- - __.
Service Provider's Name Don Thompson 8 Sons Exc LLC ; Phone 715-266 2842
_ ---- - -<.
POWTS F:egulator's Name Sawyer CountY Zonin_�_��; Phone, �15-634-8288 :
Svstem Fbw and Load Parameters
C)esign Flow-Peak 600 gpd Maximum Influent Particle Size 1/8 in
EstimaCed Flow-Average 400 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1250 gal Maximum TSS 150 mglL
Soil Absorption Component Size 600.1 (t� Ma�cimum FOG 30 mg/L
T��pe of Wastewater pomestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequencv
Septic and Pump Tank Ins t and/or service once eve 3 ears
Effluent Filter Should ins t and clean at least once eve 3 ears
F'ump and Controls Test once eve 3 ears
Alarm Should test monthl
Pressure System Laterals should be flushed and pressure tested eve 3 ears
Mound Ins t for pondin�and seepage once every 3 ears
O!i�e� i
Miscellaneous Construction and Materials Standards
1. Observatinn pipes are slotted and materials conform to Tabfe SPS 384.30-1, have a watertight cap,
and are se�cured in as shown in the mound component manual.
2. Dispersal�:ell aggregate conforms to SPS 384.30(6)(i),Wis.Adm.Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384,Wis.Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mourn�structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help n�uce frost penetration.
Lateral Tum-up Detail
Finished •������������• •��������������
Grade �
6-8"Diameter Lawn -� Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Di:sfibution
�ti long Sweep 90 or Two
� 45 Deqree Bends Same
Diameter as Lateral
i
Project: Big C:hip Outdoors LLC Page 5 of 9
I
I
Mound System Management Plan
Pursuant to SPS 383.54,��.Adm.Code
�
This system s.hall be operated in aocorda�ce with SPS 382�4 V1C�5.Adm.Code,and shall maintained in accordance with its'component
manuals(SBD-ti]691-P(N.01/01,R.10/12),SSWMP PubliCation 9.6(01l81),and Pressure DisUibution Component AAanual Ver.2.0 SBD-
10706-P(N.01/C�1,R.10/12)]and bcal or state rules pertaining to system maintenance and maintenance reporting.
No one shouhi ever enber a septic or pump tank since dangerous gases may be present that could cause deeth.
Septic a�d pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no bnger used as
POWfS components.
Septic or pump tank manhole risers,access risers and covers shoutd be inapeded for water tightrress and soundnesa. Access openings
used for service�and assessment shall be sealed watertight upon the completion of servioe. Any opening deemed unsound,defective,or
subjed to failure must be rcplaced. E�osed access openings greater than 8-inches in diameter shall be secured by an effedive lodcing
device to prevent accidental or unauthorized entry into a tank or component.
Sentic Tank
The septic taiik shall be maintained by an individual ceRified to servioe septic tanks under s.281.48,Stats. The conteMs of the septic
tank shall be disposed of in axordance with NR 113,ws.Adm.Code. The operating�ndition of the septic tank and outlet fiRer shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be deaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tsnk that may sbugh off the filter when removed from its encbsure. If the fiRer is equipped with an alartn.the
fiRer shall be serviced'rf the atarm is adnrated continuously. IMermittent fiRer alartns may indicate surge flows or an knpending continuous
alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid vo�ume of the
tank. If the contents of the tank are not removed at the time of a Viennial assessment,maintenance personnel shal�advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of balogical or chemical additives to enhanoe septic tank performance is generalty not required. However,if such products
are used they sha.11 be approved for septic tank use by the DepartmeM of Commerce.
Pumo Tank
The pump(do:�ing)tank shall be inspeded at least once every 3 years. All switd�es,alarms,and pumps shall be tested to verify proper
operation. If an e'ffluent fiker is instelled wiMin the tank it shall be inspeded and serviced as necessary.
Mound and Pressure Distributlon Svsbem
No trees or sh�ubs should be planted on the mound Plantings may be made around the mound's perimeter,and the mound shall be
seeded and mulctied as necessary to prevent erosion and to provide some protection from frost penetration Traffic(other than for
vegetative mainteinance)on the mound is not recommended since soil compaction may hinder aeration ot the infiltrative surface withi�the
mound and snow compadion in the wiMer wdl promote frost penetration. Cok1 weather installations(October-February)didate that the
mound be heavily mulr,hed as protedion from freezfng.
Influent quality into the mound system may not exceed 220 mglL BODS,150 mg/L TSS,and 30 mg/L FOG tor sep8c te�k etfluent or 30
mg/L BODS,30 m�yL TSS,10 mg1L FOG,and 10'cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specifred in the pertnit for this installation.
The pressure distribution system is provided with a flushing point at the end of each Iateral,and'R is recommended that each lateral be
flushed of accumulated solids at least once every 18 moMhs. YVhen a pressure test is perfomied ft should be compared to the initial test
when the system vvas installed to detertnine'rf orfice cbgging has occurted and A orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for eifluent pondir►g. Po�ding levels shall be repoRed to the owner,and any
levels above 6 inclies considered as an impending hydraulic failure requiring additional,more hequent monitoring.
CoMlnoencv Plan
If the septic tank or any of its components become defedive the tank or component shall be repaired or replacad to keep the system in
proper operating oonditan.
If the dosing tank,pump,pump controls,alartn or related wiring becomes defective the defective component(s)shall Ce immediately
repaired or replace�d with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surtace,it will be repaired or
2placed in its'pre:;ent bcation by increasing basal area'rf tce leakage occurs or by removi�g biologically Gogged absorption and dispersal
media,and related piping,and replaang said components as deemed necessary to bring the system into proper operating cond'Rion.
See Page 5 of this plan for the name and telephone number of your locaf POWTS regulator and service provider.
Pretreatmern Unib
The infortnation and schedule oi mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached+�s separate documents and are considered part of the overall management plan for this system.
� Project: Page 6 of 9
�
� � ���A � � � � �
V1laste�vater
METERS FEET
40� . ._ ` _ '_ , � � - -f MODELS: ;
F Pest .-.t - --=,-* - - � � � �
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PERFORMANCE RATINGS
PE31 PE41 PE51
Total Head G� Totsl Haad G� Totel Hsad G�
(foet of vr,�hr) (fwt of vrater) (iast of water)
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Wisconsa,oeaartment or safety arw Proressional services F ,�'�a �� 4g P �of 3 ��/�
Division of IrWustry Services �� ' ������" � V '
SOIL EVALUATION REPORT �
va ( ) aeTe� �. ._r...._._.. _--- --�--�- -.__.. _.�_
In aacorAance with SPS 385.Wis Adm Code I �+^�Y �Q w e
Atlach oomplete site plan on paper not lest than 8 t/2 x 11 mches in size.Plan miat indude. --�------I N
but not limited to�verttc�i and tmrimrelel'eterence �nt BM,direclion ared t sl �rx��•D• �1 �,
scale or dimensioru.noM artow.and bcation and aisiance to nearest road. O�o�-��{�'3(p- vt�� ---. '
Plesae print ail infnrmatlon. i � Reviewed by �Da/te
Personal u,rwman«, oe usea aor �aw s.is.oa txmil.--;----�-�„-.-�'�� !�i(?Y/.�1 j—
Property Owner Property Location ❑ � �
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Property Owner,,s1Maibng 1Ad�dress Lot# 81odc it Subd,Name w CStYtlf '
-(� S (,!CSS �
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I at state tip coae anone Numce. �C;�y �v0age rown Wearest Roaa"7G$8-N i
i w� s�g�l3 ��.� co.� cC
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�New Construction Use:(�Residential J Numberof bedrooms_Code d�ived design flow rate�,_GPD
❑Replacement ❑Public a canmer�ia�-Deuribe: _ �: �
ParFent materiai rJ an.� �5.tt�..ta S� .S4/-R Fbod Plan elevalion i1 applitaDle�_fl. � �
Generai comments arul recornmerMations mw•«.( s�Stu'l ; �
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' Soil A licatiai Rate
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In. Munsell �u.Az.Conl Cobr Gc Sz.Sh. •EtHI� 'Eff#2
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CS Name(P�ease ) Signalwe � � C� CST Number
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'„G���F��!��4lT c�� JUN 2 3 2021 �
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SAWYER CGUNTY
j ZONING ADMINISTRATIOtJ
❑Boring
j� Bonng}1 �PR Ground stutace elev.9�R. Dept1+to fimi�ng Factor�in.
Sal A licatbn Ra1e
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Soil A ication Rate
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Office of
Sawyer County Zoning Administratto��i�(�,��'������`�
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PO Box 676
Haywazd,WI 54843 �'�`,`� JUL 1 1 2022 '�. '
Tel:(715)634-8288 �__`__ __ ..)
Fa�c:(715)638-3277 1 .� - -
URL:h_ptt �//sawvercount�¢w.org �GN�NG tiu�t,� c�a,'1�;;�i
Email:��mine secC�sawyercountyeov or¢
. � � . . Toll Free:CourthouseJGenessl Infomiation �
1-877599-4110
Sawyer County Zoning and Sanitation"As-Built"Form
Property Owner's Name �i`i v�'`�� L��-f,�'�LY`I'� l��-
FireNumbetandRoadName ��v�'3 I`E GT� �C
Plnmber'sName Cf���c- / /�.�t�'1P��i��_
DateofInstallation ���-3fl" � �
County Sanitary Permit Number a�- ��a
iz�igit rarcei Nnmbec c�1�? �7`'lC 3(o T I�"3
Description aad Elevation of Benctunark 1 �. f�r/� ;R �e� �4 K l-�� ����"�Ci
Tan cl_.am farfis�er atvl(.'a�qrin ry(-1,'���C�C�.'C la(,��/7J li I�OM.�7
Setback-Tank to Nearest Lot Line ���'�'�
Setback-Tank to Nearest Well ��=% �-�-���� �� ���P�'
Setback-Tank to Building 3 5�
Cell Width ����r
Cell Length �J �
Number of Cells �
Setback-Cell to Neaiest Lot Line '\��`L'�
Setback-Cell to Nearest V✓ell /'�V W e�� °i� �'��E'�
Setback-Cell to Building L�L�t
Setback-Cell to Navigable Water N�
Make and Model of Dispersal Unit rn��tn�
Make and Madel of Filter IJ"7 t U� l fl"?�
Make and Model of Pump �-' ����� �� S(
-Please complete other side-
"As-Built Plot Plan"
Elevation Data
Benchmark 1,�$o Please include the followin�:
Building 5ewer 3.7p
Tank In ��,;,Z� • Location of observation and vent pipes
Tank Out '(.5 O •Feet of risers used on tank(s)
Dose Tank In — •Location of benchmazk and North arrow
� Dose Tank Bottom . ,3� • Location of all components
Header or Manifold !.8� • Length of pipe between components
� Distribution Pipe l.��, • Number of chamber units in each cell
System Elevation �t ;� • Location of well, lot lines and road ����
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