HomeMy WebLinkAbout016-637-22-3201-SAN-2022-216 . Indus�n-&Tciccc I)i��ision Counn� �
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Sanitary Permit Application �'�'°'°""�"``",':"",n_
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-�rxryir�d pnnr�n ol+lainine n v�niian ry.rnui.\ni�:\pplicnlinn linns ti�r sla�o��aiul IM)\\"f5 arc v�hmitl�vi in Pmjcct.lddress�if difl�crst thnn mailin�u .�
tl�a 1Je�u�i�mant nf Falotr nnd R�,f�,ironl Son;e4c.Pers�n:d inf u�ti�ei vou pmvida mn.�ha uurl f�ec�ndnn� �
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1. A� lica[ion Information-Plcasc Print All Information (1096N S7a7E HWv 2�)
ir,��w,y o„„�,,n:����� i�.���<i ol6-63 7-�-3�I
DANIEL DEAN �,,,1�L ��� 57-016-2-37-06-22-302-000-00�010
Irupeny lh.n�,�.nlailin�:1dJmsx liu�x,rl.lawati�m
2953 28 1/2 ST - ._
Ci1.:R�ale /ipC�xfe 1'h�vicnun,n�+
- NW SW .,.S,:c�iai 22
BIRCHWOOD WI 54817 ( � (circic�Hi�
7L T�pc nf Building(chcck aIl that apph�) 1„��.� -I' _ 37 �-. It 6 �,u�
J01 or 2 Pnmiiv n��allin„ KunJxr„I'iicdn.,m. 3 — SubJivi.iim\umc ^
ISI�xA i
❑I'uhlic C�rmnorcial-I lcscriha 1:.c _
❑Cih ol
❑Suuc Un�ad-Ws<riba Uw CS\I tiunilxr ❑Villageol MEADOWBROOK
� �To��nnf
IIt.Typr of Pcrmit (Check onl��onc boc on Iinc A. Cumplc[c linc R if applicaM1lc)
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�t. ❑��,�,,,�i a�,,•���i ❑ve�„�i e�;,��„ ❑c��A�„r�,rw���»n« ❑r�,���irTo,rT a�x��� i.�.i r�.���,��.r��„�i n���„i,�•����a n:�i�i.a�,.i
Rafivo I;spirili�n (h�nar
IV.Tc e of POWTS Scstem/Cnm onentlDevice: Check all that a Iv
�Vi�n-17.:.�uriiul L�-linxind ❑1'r��wrii��In-c;n�unJ ❑,ll-l�ra�� ❑AluwiJ_ZJ in.��I wilaUi.:.x,il ❑\luund��-1 in.ul u�ilabl�.x�il
❑ilolding"I�nnk ❑��horlN.s�x.uJC�xnpmcntlo�plainl_._________.__________ ❑IYatn;alm..nlia;�ico(oxplain)
V.Dis crsalITreatmcnt Area Inf�rma[inn:
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VI.T:Ink Info CapaeiK in Tolnl 'of 4famdiiclurcr
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'q.o��.n,t,: �1�n y�.�ol�: _' ' '
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sern�,.�iioid�����i:��,� �ppp ;000 1 WIESER X
I)�nin�•.�'h:iinh.r
Vlt.Refpunsibilih'Stutemcnt-i,ttu,undeisipkJ,assunn resp,nsibJin�r.r in.tuua�iun urefr 1'ON'IS slwwn on��w a�mrlxJ Mam
Nlmnher"s�amelprinq Phrnh�rs5icnauir� \IP'�IPKSNumh.r ifu�inassl9iaic\umh.s
CALEB PRUSINSKI �I
MP-7002396 (715)65b9215
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W759560LD HWY 14,WEYERHAEUSER,WI.54895
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IX.Conditions of Appmral/Rcasons fur Disappro��ai 7aa. a'3 ._ ....,.
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:umch m�omn��t�ni�m m��he..�.����.od cubmi��n Ihe fnunh'nnl)'an paM'r nol levs�W�n X Ir1��l iix�L-
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sisn-�>�va�k_nxiia� NOREFJNDSAFTER � AUG � 6 YO2�
ISSUE OF PERMIT
SAWYER COUNTY
ZONING ADMINISTRATION
Pa�c I of 6
Private Onsite Wastewater Treatment System
Indcx aud Titic Pa�c
Projcct Namc: DANIEL DEAN-3 BDRM INGROUND POWTS- (NEW)
O��mcr's Namc: DANIEL DEAN
Owner's Address: 2953 28 1!2 ST
BIRCHWOOD WI 54817
Lcgal Descri��tion: Nw , SW , 22 , 37 N, 6 W
Munici�)dlit�': Tunn, 6"t�(age, CjEi� of MEADOWBROOK
County: SAWYER
Lot Numbcr: Blcxk Numbcr: CSM Number:
Sub<li�'iSion Name: ( 1096N STATE HWY 27 )
Parccl I.D.Numbcr. 57-016-2-37-0E22302-000-0D0010
Pagc t Indcx and Titic Pa�;c
Pagc2 Plot Plan�vith Cross-Scc[ion&Plan Vic�r
P�g� ; ScpticTank Spccifications
P�g�'4 POW'1'SU«�ncr'sNlanual& ManaacmcntPlan
Nage S POWTS O«ncrs Manual& Manaacmcnt Plan
Pascb Filtcr Information
NameofDcsi�ncr. CALE PRUSIN �f(I Liccntic#: MP-1002396
Sibnaturc ��cYl.v-(J � Date: l.X� ' �1lU' ��
I)csitn��d�iunuanilolhc(ollo�cin�PO\N'I�S('au��oni•n1\lamulandf)SPS i81-i85:
113D-1070i-P(V.O VOI. R.10/12� "LrLruun�Joi�.l6eor�riion Cum�>un�•nl!1lantui�"V�cr�ivn�
:ARa�i�menl: Soill[�aluiiionR��orl •
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= DANIEL DEAN ( 1096N ST H1�JY ?7 ) � �LOT PLAN ���
� T_ 0� iviEAD01VBRO0h. SA��'l'ER CO. / ��
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CROSS-SECTION (NO SCAL6)
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LNUCAI S (12 \7�'Xl2")
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AL.L SYS 38;.i3 �
SF�I IiACKS MEI�. j��
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W�P1000—MR
g TANK SPECIFICATIONS � o
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m s'-s" a �
DIMENSIONS: � o
WAL�: 2 1/2' a �
Z 4" C4S7-�-5=A1-�� -4" CPST-A-SEAL BOTTON: 3" i �
COVER: 5"
__--____ MANHOLE: 24" I.D. PRECAST CONCRETE RISER a
� �' � HEIGHT�. 53 1/4' �'
�i�� �:� LEN GTH: 8�_9"
i ,/ �
I. �, ' �\� WIDhI: 7'-2" x
�'� �i _ o%� �� BELOW INLET: 42' �
Q r ---�
� � ' `� � V � LIOUID �EVEL: 36� ��
`i� � � i WEIGHT�. 6,790 LBS. :��I a o; E
�. i u � �I
' ` � ` '�,�� INLET AND OUTLET: = s � �
�\ ''
��� FILTER Ok-'� `.'i 4" CASi-A-SEAL B00T OR EOUAL GASKET �! 'm o 0
', �a\ BAFPLE i�� INLET AND OUTLET BAFFLE AND FlLTER: �I 3 � 3
��.
� - ______-, l WISCOMIN, SEE DETAIL //10 '''�, � � �
(OTHER STATES SEE CHART) 41 � �
LIQUID CAFAqTY: 27.83 GAL/IN ~ '
TOP VIEW W :,,
HOLDING TaNK: �' �
OUTLET HOLE PLUGGED � � u°
ACTUAL CAPACIT/: 1,085 CALLONS � � �
LOADING D=51GN: B'-0" UNSATURAlED SOIL � � �;
� c:
� TANK CAN BE USED AS: � o I
c;� SEPTIC / HOLDING / PUMP OR SIPHON W , o
Q� ' �:
- x
a COVER: MIX DESIGN �y8 (NO FIBER) W .;
� , `n 1� � ) :�
TANK: MIX DESIGN 10 STRUCTURAL FIBER � .
--- ---- �_ CU570M12ED TANKS: � '�
iI�ILET - FOR CLSTOM TANKS CONTACT NIESER CONCRETE
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REVIEWED BY � U
;.� 'U�U� p.aD REVIEW DATE � F
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DRAWINGS SUBMITTED N
SIDE VIEW FOR APPROVAL
APPROVED BY: 5-�EET ri0.
AVPROVAL DATE: �
F�
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENiS VRODUCTS NEEDED BY: ��
Pag� y �f b
POWTS OWNER'S MANI�AI,AND MANAGEMENT PL,AN
FILEINFORMATION SYSTEM SP@CIFICATIONS
O��ncr DANIEL DEAN Sc itic Tank Cipacitl� 1000 �a] O NA
Pcnnit N Sc tic�Cuul. Munulucturcr WIESER ❑ NA
DESIGN PARAMETERS P:fllucnl Filtc�Manufacturer BEST ❑ NA
Numhcrof I?cdroom.11fN1 .�J/bcdruonU 3 1`.Illueut I-illcr Modcl GF-10 ❑ NA
Nmnbcr uf Cununcrciul Uuiis Pwup'fank Capacity gal �+ NA
IfstimatcJ Ilo����uccra�c� 3pp Eal/dac Pum i"fank Manut;ichucr ❑O Nn
Dc,ign Ilo�� IDWP) =estimalcd� Li qsp �aVdar Pwup Mauuluclurcr �NA
Soil Applic;Aion Ralc ,7 gal/dar/�IZ Pum i Modcl O NA
Prc[roatmcn� I lnil f m NA)
1nllucndliffluent Qualih�(O NA) onihl}� Aecrage � >..
❑ Sand/Gr,i��clPiltcr O L�alPillcr
C.iM.Oil K(ircase(POG) _zU mE/I. ❑ MeclEiafcal Aeral�on ❑ W'�lland
13icehcmical O���gcn Ih;mund(130U,) _?ZU m@!L O Disinfection ❑ Othcr:
lbtal Sus�iendul tiulids(Ttiti� _I ill mg/I, ManulLctunr Modcl:
Protrcatcd I:Illucnl �ualil� (0 NAl onllil� Avcri�.c Soil Abso��lion Coinponem f0 NA)
13iochcmiwlChypcnUcmand(ItUU:I _:Umg/L. �' ImErounJlgra��ih�l ❑ln-pround�pressuriuJl
Total tiuspend�tl tiolidz 1'fSti) _:0 mg/I, ❑ At-gradc ❑ Mound
Fecal Coliiomi fgeomelrie memu _10 cfu/I Oihnl. �Urip-li��c O Ut6cr:
Vcrtical Dfstancc PnnA Roitom to Scn icc Pad- 30 II
Masimum1il11ucnLParlieletiiro USinclidiameter 1[uriioiU.dDisl:mecTouA(s)IoCarviccPad. 5 it
Dispcn:d Llnit Mf�.lModcl Numbcr: WFILTRATOR QUICK4 STANDARD CHAMBERS� NA
Calcululions:
Soil Di,persal r;ndCap IDisper;.dUnilliltiA)
I)WP - nnnlicntion Rntc = Arcn Rcnuirod - Ii15A - or t�l'rcnch \Vid�hl = k Ilniu or"folal I.cneih u�'l�rcnclit+)
_450_,_ - ___ J __ _ _ __642.9_ - �3�2 - 20.OSQFT = 32 CHAMBERS
- _____ - _- - -_____ . _-_-___ .._
DESIGN CRITERIA �� - "'�'7�[nrr-.�r� 6532 SQFT(TOTAL)�
O "Dc,ipn of Pres�urc I�is�ribution Nct�corks lor�ptic Timk-kil Absorplion Scsmms" Publication 9.6(SSW"MY Manuall
❑ "ICC Plo��tcch Moimd Cumponcul Mauuu]" Vcrsiun 11
fl "LG l�lu�� Mound Component Mmmal" Vcr,ion 8/'_0/2tN)7
O S13U- IOR��-P U2.1'I')"At-Gi�Je Component Vtanual Usin�Pressure Distributiun" �"crsion'_ll
� S13D- 10705-P(N.01/011"In Gronnd Soil AbsoiptionCompuncnt Manual"Vcrsion2.0
O SI3D- I OG91-P(N.01 '01)"Muund Componcnt Manual" Vcrsiun LO
O tiBn- 106$7-P 1R.6,9y)"Drip-linc f Illuenl Dispo�:�l Componcnl �I:mual"
O RRD- 107U(,-P(N.iiUUl 1"I'ressure Di.tribution ComponeN Monual" Vercion ?.(i
r1 OILcr�.
MAINTENANCE M1fO1VITORING SCHEDULE- MAIIYTENANCE AND MANAGE117ENT
Scr�iCe E�cni Srr�ire Frr� uanrc
Pump�inspccl dispers,d cell(sl.clrnn liller A�Icastona:cven�: m I; monlhs � i years �Ulhee
Inspoe� .um�K �um�cnntrols,alarm.prclrt.al�nenl w�ii AI Icatit oncc occic� ❑ months O i vcars m NA
I�Iush:mJ n'casurcicsllaLcrals AIlcu,luncececrc: ❑ ntoulhs ❑ i ��cars � NA
START UP AND OPERATIOIV: Pi�r uca eonstnielion. prior tu using lhc PC)WTS ehcek lrcutmcnl tunkul ti�r �hc pRscncc ol pau�tiug
pruducts ur olhcr chcmicals that ma� impcdc thc trwl�ucnt proccss und/or dmuagc lhc dispersal ccll�s). 11 hiph cunccnhiitions arc dcicu(cd harc
the content,ol the I.vil:(s)r�7noacd bc a upiape sen-icing oper.nor pnur to u,e Srstem ctartupshall notcecur��hen soil conJitions are froren
at thc infiltr:rtice�urfacc.
Iltc propert�� ot�ncr is respousiblc Ii�r Ihc operaGun and mainlcnunec ol llic PUWTS .md submiviun ul rcyufrud repurts. �Ihe ymintitc au�
quali�c ol thr ��asic��ntcr ,Ucam �cill aticet �he perliimiana-and �onge��itc ol vour P()Wl'ti. lhc in,lallalion ol��ater-surinE appliances anA
fidures along �cith prompt repair of Icaks reduce,ihe��astcoater rolume. Also thc hrine or��aste Gom �cmer .oftencrs. iron remo��al �mi�s.
utha� cic:n �vdcr Imatmcnl dccfccs anJ limudaliun dmins shuuld bc diu;l�argcd lo Uic Eroimd sudacc ���hencccr possiblc. Nuta this ducs nul
includc luuudt����asto.shu��crs dish�+alc�,utc.
9'hic�cstmu is dcsigncd �o handlc dnmesHc strcngth ��a,lc�calce hmceccr. �hc dispns�l oY�i�nd ha.rd �+rcnscs, oils_ ccpul:iMcJl�ui� pccls_
secds,buncs.and Cuud soliJs,such as lhosc pruduccd bc a Earbagc dispusal xhuuld hc minimizcJ. Toilcl lissuc is thc unly paper tlia(should
be dischar�ed inlu Ihe sYstem. 1)ther non-biodegradable dems. such as bahp wipes. ltunpuns. sanrtan napkm, condom,.ci�areite bulls.
clental floss_ and cotton s��nh,. should not eNer lhe ,c,tem. Chemical,. ,uch ns petroleum proJuct,_ painL disinfecimits. pesticides.
nntibiotics,soh�cnis.ctc..should nol bc tlushcd inlo Ihcscs�cm bcc��sctLc��can sc�iousl}� damagc�aurPOWTS and conlaminalc��our
Page 5 of 6
dri�il:iug onlcrsupyh�. Mainlain a rcgidarslcadc flo���bc sprcadfng laund�� ��ashing diroughoul thc�rcck.A�aid vchicic I�nffic occr
all scslem conqwnents. Compaction ofsnoa ocerihe dispersnl unil ma}�c�use il to frec�c up.
INSPECTIONS & MAIIYTENANCE: Inspection shall bc madc bc un indicidwl camin� unc ol thc lullo�ciug liccnscs ur
cerlilic.itions: ivtasler Plumber. Masler PlwnFnr Restricted Sewer. PUN'TS MuinWiner, or tiep4iEc Sen�irin� Uper.LLur 1per Ihe alWched
Maintenance Schedulcl. �fanA inspections must inchide a ��isual in,pec�ion ol ihe tank to identif�� anc missing or hroken hard��ara.
idenlit\� any cracks or lcaks. mcasurc thc��i�lumc of romhincd slud�c and scum and chcck litt an}' b:icknp or pnnding ol dlluunl tn Ihc
gruwtd surl:ice and Irst all cicclrirnl eyuipincnl .uch as pumps and alarms. Am dcl'ecls shall be prumpll� correcicd I��pu.cd openings
�reater Ihan `t inches in dimneter shall be secured o��ih efleclive IocFing devices �o precent accidmilal or unauthorized entn�ihe tanks.
Whcn lhc corobinalion of sludgc and scum in anr tank cccccds onc-Ihird 11/3)or norc of Ihc lauk�alunu, Ihc cnlirc conlculs of thc
lank shnli bc rcmorcd b� a Scptagc Smvicing Opcmlor and disposcd of in nccordancc��iIL Cl�. NR 1 I;. W isconsin Admin. Codc.
Spccilic xn�icinp murhanics must hc pruri�cd il ccrtical is>I�Ica or il'huritontul is>I�U I�rot and initmclions lo lx pro��idcd bdu�+.
Thc ouUc��Itcr(s)shall bc fnspccicd and cicaucd to rcmocc any xcumula�cd solids accordineto mnnufaclurcr's spccifica�ions.Solids
�cashcd from Ihc filtcr sliall bc rclaiucd in thc lank.Filicr cicauing mac bc ncccssap at morc froqucnt iulcn�als thm� slalcd in tho
mnin�cnance schcdule io kccpihe system operetin�,.
Al:im�s shoulJ hc Icslcd ou a rcgular ba..is br Ihc humc o�cncr. If an alnrm sounJs. contaet an individiml liccnscd lo scn�icc POW�I'S,
Thcrc �s nurmallc a I da� rescrcu widcr ngular operati�ig conditions.. l�u��cvcr watcr should Ix cunscrccd unitl any problcros ��ilh U�c
sc+tem ure eorrecled to precenl hack-up ol se��age into�he d��ellinE or surfaeing.
ABANDONMENT: Whcu thc POW'iti laih and/or is pcm�:mcutic I:ikcn uul al scn�iac Ihc fnlluoing slcps shall bc. lakcn k�cnsurc thnl
�Lc .)�stcm is q�uperlc uud s:dd� abundoncd iu coinpiiancc��ith Ch. SPS tR3.::. Wisconsin Admiu. Cudc:
• Ali pipin€to lanks and pits shall bc diswnnected and the nbnndoncd pipc opaiings scalcd.
• �fhc contcnis ol all t�mks and pits shall bc removed and properh�JisposcJ o(bc a Scptagc ticn-icin�Operator.
• ,�Ilcr pumping. all tanks .ind pi�s shall hc c�ca��atcd and romo��cd ur Ihcir co��crs nmo��cd and thc ��oid spacc 1511cd oilh suil.
pru�'cL. ur uUur incrt solid ntalcrial.
CONTINGENCY PLAN: IY the P(1W'I'ti tails anJ cann�ri he repaired the follo�cing measum,ha��c bcen.or must he taken. �o pro��ide+i
cudc compliant rcplaccmcn� scsicm:
O A .uitWblc rcpl;iccmcnl arc:i has Ixcn c��alu:ifcd aud m:ry bc utilizcd lix lhc localion of a rcplaccmcnl soi I absorption s��stem. Tlic
rcpluccmont urca shoidd be proluctud I'rum dislu�b�ucc and compacliun and shuuW nol bc infrinr�cd upon b� nyuircl sclUacks
irom e�Sslin�und pruposed structum, lot lines and �cells. 1'ailure tu prutect the replacement area renders i� unusable. Replucumenl
.��,tems must cnmply with the rulu,in el7'ecl al the time ol replacement.
O A suitaM1le replacement �rca is not a��ailahle duc to selhack and/or soil limifa�ions_ 13nrrinF nd�:ince, in POWTS �echnologc a
holding lank.ma�� bc installcd as a last resorl lo rcplacc Ihc I:iilcd POW`I'ti.
m '17�c silc has nol bccn c��alu:dcd to idcnUly a suitablc rcpl.iccmcnt uroa. Upou laSlurc ul lhc POW"1�S a suil and silc cculualion musl
be perlittmeQ tu lorde a suilahle replacement areu. 11 no replacemenl area is acailable n holding tank ntav be instulled as a la,�
resort lo repiacc Ihc fuilcJ PnWT�.
O Mound and at-Eradc sofl abso�pliou s�slcros mac bc rcconsUuctcd in placc follo�riug rcmocai of thc biumat a� ihc iidillraiicc
surface.Reconslmctions of such scsiems wast compl����i�h thc mlcs in cffect al ihat timc.
WARNINC!!:I SEPTIC, PUMP, AND OTHER TREATMF.NT TANKS MAY CONTIAN LETHAL C.ASSES AND/OR INSUFFICIENT
OXYCEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEAI'H
MAY RESULT.RE5CUE OFA PERSON FROM TIiE INSERiOR OFATAN K MAY QE DIFFICULT OR IMPOSSI6LG.
AI)Dlll(�NAL CUMMNNTS:
POWTS 1NSTALLER POWTS MAINTAINER
N�����- CALEB PRUSINSKI MP-1002396 Nnmc: pRUSINSKI PLUMBING
Vhcina p15�651-9215 Phnnr (715)651-9215
SEPTAGE SERViCINC OPERA'POR Pum mr LOCAL REGULATORY AUTHORI7'Y
Nanu- Name: SAWYERCO ZONWG
1'hunc.- Yhonn: (715)634-8288
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�Installation Instructions for the GF10 Filter Maintenance of the GF10 Filter
A 9mc frame m wh�¢h sep[ic[anks are�erviced is set 7y s�ate and Iocal codes.
. ,.j*� ,. .� . � .��.+ .� a�d+���-� qhhcughiheymaybedMerenLmostiegulatoryaqenciessuqgestRvotofive
- years.Werecommei�.dtheGFlOfilreitedeanedmihenthesepri<tankisnormaily
d � �' deaneAandpumped,orasneeded. �
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WARNING: Ifthe 'iquid level in the tank is above the top oi ,he
OQ Q : filter, pump the tank prior to removing the filter cartridge.
Stepl:Locateandremove steP:: sero�e��sca�ia�����, s�ev3� Fo�����a��a���������� O CAUTION:USE RUBBER GLOVES WHEN HANDLING FILTERS!
�heseplictankcovzr,or placethefiitercaseonto requireordesirradditional
theoutletsideoftank. Iheoutletpipe. Makesure supportiifaddrtionalsupportis St¢p1: Removethesep�i<tarkmver
tl�e case is positioned so �01 needed,go Io Step-p Glue a
ihefiltercanberemoved seaionoft"Sdi.40pipetothe ardpumptFetankifnecessaryto
from the tank for mainte- Rvo hu6s locatetl on the botmm prevent any solids from escaping rothe -�""
field when Ihe filter is removed '
nanw and service of the case and the hub bcated E � � .,,
onthesldeofthecase. ��q,��r. �m✓�r � �. � ���
�'.�+A„a;,rs. � wtl"`.. FAF�A9A�4+ .- .- ••m++�, h� �r �A
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Step4rCluethefiltercaxeonto StepS� Porinstallation,whereitwill Step2:Pullihefilrer Step3: WhileFoldir9rhe Step4: InzeruhrcarlriAg=
the outlet pipe. Insert the filter be diffi<ul[[o reach the handle,plaw handle and slide the filter filter cartriAge over the back in�o�he<ase makicg
carMd9elntothecase.IMake t"Schedule40pipeinmtheteeonthe outofthecase. accessopenin9ofthetank, suretMztitisproperly
sur.�thefilteriscompletely handleandextendittoheightthatwill rinsethecartrid9eoffwith aligneAardmmpletely
in;ert=dintotPecase.) makeiteasytoremovethefilter. freshwatecTakecareto insertedintorhecase.
make sure all solid material
�` falls bzck lnto the lank
/�BEoST
Installation of an 5ameasanews stemonl theseptictank �BEST
Y Y / TECHNOLOGY
eXl$�lllg SyStfTll. mustbepumpedprlorminstallation. ,
a F���=�eid ei�,i,v;,,n�..,,�•:�,;i,a osi9z
. . YB]]�'165�9565 fax�.?U3-Y&1-&5W
Sawyer County Zoning and
Conservation Administration �i'������:�
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10610 Main Street, Suite 49 � ���c,��V�
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Hayward, WI 54843 ...�j ��� ��j'
Tel: (715)634-8288 � �� �%` C'�
. Fax: (71�)638-3277 - �� p �6 �OT �D
URL: http:��Sa�ti�vLrc��iu�tv:;�v.<�r�:, � YE,q� �
EmaiL• zonin=t.sec!ir'sa«�ercc�unTy�?c�v.ors, '�D< <`(�.�/� .J
�1,;'v/�� � Y
Toll Free:Courthouse/General Information "r��,�T�oM
1-877-699-4110
Sawyer Couoty Zoning and Sanitation "As - Built" Form
Property Owner's Name ��' ►�ll�� � ��
Fire Number and Road Name ���_,�_���]��G�-f w � � 7
Plumber's Na�ne CQ�� � t l.`,��+n��
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Date of Installation �_�� �_ __���_�.
County Sanitary Permit Number � 3���
12 Digit Parcel Number ���0 � ��J, �' ZZ— �.��
Description and Elevation of Benchmark �� •� ;
Tank Manufacturer and Capacity � i��� �('�,�,,bC(,����
Setback-Tank to Nearest Lot Line
Setback- Tank to Nearest Well
Setback- Tank to Suildina
Cell Width 3 1���
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
+ Grv11 �
Make and Model of Dispersal Unit �1.��, _�� ��Cl) �Q �'J ��
Make and Model of Filter - C.�j � �
,�r..�.�....,a �,�,,,�,.� ,_rn..�-... I� � �11
- Please complete other side -
"As-Built Plot Plan"
Elevation Data
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,--- � f � ,, . .
3enchmaxk � � j�� Pleas� include the fallou�ln :
.
3Ul1d1�1g Sewer �; ` �, ';.-� t � , -
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�ank In 7 { . � • Location of vb��rvation and v�ent i es
, � � �.� � �
, a n k O u t � �� �� • Feer o f risers use d an t��n k�s)
lose T a n k In • Lacatian �f b�nchmark and North arro�
)ose Tank Bottom - Location of all components
�eader or Manifold � ` �' �
�_� � � • Length of pipe between components
)istribution Pipe � Number of chaznber units in each cell
�ystem Elevation � ` ��;�`'� • Location of well, lot lines and road
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