HomeMy WebLinkAbout014-841-06-4310-SAN-2022-274 ,���;'° ,"�% Department of Safety c°°"ty �
�� S aw e� �
�, • �= & Professional Services, �
��� � Sanitary Permit Number(lo be filled in by
� _ ��; Industry Services Division
\'�ry`-f;f � 3 �as � �
::;a �
Sanitary Permit Application State Transaction Number ,
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn to the appropriate govemmental unit J
is required prior to obtaining a sanitary permit.Note:Application forms tor state-owned POW'�S are submittcd to Project Address(if diflerent than mailing �
the Departmcnt of Safety and Vro�essional Scrvices.Personal iniormation you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.041 I)(m),Stats. ��•�jOK �.r
L Application Information-Please Print All Information
Property Owner's Name Parcel#
�0.50� P aerSon . Cole�� /'1 �3 1; 1e. OW- $yl - D(o 43� 0
Property Owner's Mailing Address Property Location
4 l0 3 Wc�k R d co�t_�oc
City,State Zip Code Phone Number
WvC�Sb� �
W Z 55/0 I (p _��_---%,�'/�, Section �o
[I.Type of Building(check a(1 that apply) Lot# T y � N R 0 F)
�l or 2 Family Dwelling-Number o(Bedrooms � 7� Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑ Village of
#'a 1 �y �'1 own of C..G'f1�'O O'F
v. 34 • »e
IIL Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i
a licable.
1.
�lew System ❑Replacement Systcm ❑ Other Modifica[ion to Existmg System(explain) ❑ Additional Pretreatmcnt lJnit(explain)
B' ❑ Holding Tank �In-Ground �� ❑ At-Grade g � yp ( p )
❑ Mound ❑ Individual Site Desi n Other T e ex lain
(conventional) Gtm'r�+��
C. ❑ Renewal Before ❑ Revision , ❑ Change of Plumber ❑Transfer to New Owner �st Previous Permit Number and Date fssued
Expiration
[V.DispersaUTreatment Area and Tank Infor ation: 70 f�' Geaw•.�f :n S. 5' w: �t �e 11
Design Flow(gpd) Design Soil Application Rate(gpel/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
�►sd �.o aa5 a��•5 � 9 c.. � 'a
Capacity in Total #of Manufacturer
:3
Tank Information Gallons Galbns Units D � U v N �
New Tanks Existing"f anks y c � L y p � �
CDlhc,�a �
n. V v� �, v� c,. �. a
Septic or Holding Tank
�bo b �bvo : Cr ne�)t
Dosine Chambrr �p O � �OV
V.Responsibility Statement- 1,the undersigned,assume responsibility for installafion of the POWTS shown on the attached plans.
Plumber�s Name(Print) Plumber's Signatu • MP/MPRS Number F3usiness Phone Number
-rra�:s 13�i�er�e Id t�sas�9 ��s-�SS►- St7(o
Plumber's Address(Street,City,State,Zip Code)
1ti3�-1�w S���e Roa.c� �� 1-�a w���, wz �'8Y3
VI.Co nt /Department Use Only
�A p ove ❑Disapproved �'�rmit Fee Date Issued Issuing Agent Signature
�V1� ❑Owner Given Reason for Denial $��'`� � ��I�a �'�^�'^��`'�-��/�
Conditions of Approval/Reasons for Disapproval
� _°� �a��q Ja�/aa � � � �� V �
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G � ,. . � �- �
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: �,
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CS�T'��- 1 � S �� � __ �
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Attach to complete plans for thc system and submit to the County only on paper oot less than 8 tn x I1 inches ib size ,
NO R�FJNDS AFTEfl `"�a 3�(v
SBD-6398(R.03/22) I�SUE OF PEfiMtT
GeoMat IN GROUND AND DOStNG DISTRIBUTION COMPONEN7 DESIGN
Residential Application
INDEX AND TITLE PAGE
.wner lnfo` _
Project Name: ANDERSON/BELISLE
Owner's Name: Jason P Anderson 8 Colette M Belisle
Owner's Address: 963 Wert Rd
Hudson,WI 54016
roperty Info _ _ . ._
Property Address: Brook Lane(Lot 78)
Legal Description: SE SW S 6 T 41 N R 8 W
Township Lenroot County:Sawyer
Subdivision Name:
Lot Number: 78 Block Number CSM#: 8124
Parcel I.D.Number: 014-841-064310
Plan Transaction No.:
Index Pages _
Page 1 Index and title Page 9 Plot plan
Page 2 Data entry Filter specifications
Page 3 GeoMat dist.cell drawings&calculations
Page 4 Lateral and cell cross section
Page 5 Management&contingency
Page 6 Maintenance&specifications �,�a�o Pump Specifications _
Page 7 Tank cross sections
Page 8 Distribution media
Travis Butterfield License Number: 652879
Date: 09/22/22 Phone Number: 715-634-8176
Signature:
Designer amp: State of Wisconsin Approval Stamp:
Designed Pursuant to the
GeoMat In Ground Component Manual Ver.June 26,2018 Version
Page 1 of 10
In Ground and Dosing Distribution Component Design
Site Information
R Residential or Commercial Design N ISD Required?
300.00 Estimated Wastewater Flow(gpd)
1.50 Peaking Factor(e.g. 1.5= 150°/o)
450.00 Design Flow(gpd)
0.00 Site Slope (%)
96.42 Prop. System Elevation (ft)
� 46.00 Depth to Limiting Factor(in)
1.60 In-situ Soil Application Rate (gpd/ftZ)
98.25 Lowest Original Grade Ele. In System Area (ft)
98.25 Highest Original Grade Ele. In System Area (ft)
94.42 Limftfng Factor Elevation (ft)
0.33 Depth Below Grade
dis n u on e i Information
3.25 Cell Width (ft) 1 Number of Cells
2.00 Dispersal Cell Design Loading Rate (gpd/ftz)
2 Influent Wastewater Quality (1 or 2)
DPstribution Infortnat on
E Center or End Manifold, Dist. Box or Drop Box
1 Number of Laterals System dosed Y
3.00 Lateral Spacing (ft)
8.97 Forcemain Drainback(gal) Does the forcemain drain back? Y
0.50 Forcemain Filter Loss (ft)
2.00 Forcemain Diameter(in)
55.00 Forcemain Length (ft)
93.00 Inside Pump Tank Elevation (ft)
3.50 System Head (ft)x 1.3
5.52 Vertical Lift (ft)
0.76 Friction Loss (ft)
1028 Total Dynamic Head (ft) Designer must enter friction loss and system demand (apm)
53.97 Minimum Dose Volume (gal)
25.00 System Demand (gpm)
Manufacturer In orrriation
Treatment Tank Information Effluent Filter Information
1000.00 Septic Tank Capacity (gal) Lifetime Filter LLC Filter Manufacturer
Wieser Concrete Products, Inc. Manufacturer LT 1/8 Filter Model Number
Dose Tank Information Gallonslinch Caiculator lopticnal,
602.82 Dose Tank Capacity (gal) 602.82 Total Tank Capacity (gal)
11.82 Dose Tank Volume (gal/in) 51.00 Total Working Liquid Depth (in)
Wieser Concrete Products, Inc. Manufacturer 11.82 gal/in (enter result in cell DoseTankVolume)
Project: ANDERSON/BELISLE Page 2 of 10
In Ground Plan View
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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_ I
alculations .
I ft A 325 ft Basal Area Required 281.25 ft1
K 1 ft B 70 ft Basal Area Proposed 367.5 ft2
S O.00ft L 72ft
W 5.25 ft
Basal Area Calculation GeoMat Dis ersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
450 1.6 gaVsq tuday 450 2.00 gausq fuday
Total 28125 ft� Total 225 ft2
Pro osed 227.5 ftz
Number of Cells 1 GeoMat Width 3.25 ft
Cell Length ft Lineal Feet of GeoMat Required 69.2
Min. Cell Len th 692 ft Lineal Feet of GeoMat Proposed 70
Cell Spacin 0.00 ft NOTE: Min S dimension= 1'
S stem Elevation 96.42 ft
Limitin Factor 94.42 ft
Se aration 2 ft rMin
Directions
Play with cell length to get desired cell spacing length and width_ Remembe� systerr SHOULD be longer than it is
wide It mus, alsc Satisfv basal loadin rate and GeoMat cell loadin ra'e
Project: ANDERSON/BELISLE Page 3 of 10
End Connection Wteral Layout Diagnm
. _ . ._ : . . . . . . . . . . . . . _� -
, .:.
Hole spacing is every t2'. V7'hole at 4&8 O'clock,starting 4 O'clock 6"finm end and
8 O'clock Holes at 12"from end.
Lateral Spacing 3A0 ft Pipe Diameler 2.00 in
s o e ross e on ,
, �g q a F� � �,�,��„�� � �wxv �v
� +o . .. � �
�t!`4� G �+O I���� 12"-aa' e.nra [tetlLerd
b` a\��' 0.33fl — :
G��"�r�" 4 ... � �;�--.
•��;f'�SY apeAa - '� I%M FmRo-euw
.,o' � ct1� - . ...i r�o� i�'-�- --
d�P ropofgeomattobeata -�. ..,.. - _ � -� ��: - � �_GFAMAT
beloworiginalgrade � � I � I � I ��TM33.`'-'� ( i I , I � I � I CampmmS
]n5ltrariw Stia6a
` I ==_NATIVESO(L�--J-�
,� `� 4�===----------- l � r�,zea�
as� _.
erva onPipes . . .. . _.. . . . ._.' -
�++m�
98.25 fl "�1°e°0f0e
I II
12"Min. �,._ .��a. I
48��M�- �j �
..� �
Sbe
r„o r�1, i -n.n.,,
�i&t. � ' � �!
�,�,, � � � 1 '_
�,,,���,,.� , ,ro- �
',�='��_,;��
96A2ft
Projecf. ANDERSONBELISLE Page 4 of 10
Notes/ Maintenance Requirements
MANAGEMENT PLAN
This private onsite wastewater(POWTS)has been designed,and is to be installed and maintained in accordance with SPS 383,Wis.Admin.
Code,the io-Ground Soil Absorptfon Component Manual for Private Onsite Wastewater Treatment Systems Version 2A SPS-10705-P
(N.OilOi). GeoMat in ground Component manual Version 1.
1.This POWTS has been designed to acwmmodate a maximum daily Flow of 45Q,79Rons of wastewater per day. The quali[y of
influent discharge into the POWTS treatment or dispersal component shall be equal to or less than all of the following.
A monthty average of 30 mglL fats,oil and grease
A monthly average of 220 mg/L BODS
A monthly average of 150 mglL TSS
Wastewater shall not discharge to the POWTS in quantdies or qualities that exceed these limits or that resWt in exceeding the enforcement
standards and preventative action limits specified in ch.NR 140Tables 1 &2 at a point of standards application,except as provided in DSPS
383.03(4),Wis Admin.Code-
2.The owner of this POWTS is responsible for system operation and maintenance.
3.Defects or malfunctions identified during maintenance described above shall be repalred in conformance with SPS383 Wfs.Admin.Code,
and the pertaining county Private Sewage Systems Ordinance. The users manual,provided to the owner of the POWTS includes the names
and telephone numbers of the properly licensed individuals to contad for such repairs.
5.No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Dept.
of Commerce in accordance with SPS-384,Wis.Admia Code.
6.If the POWTS is replaced,or its use discontinued,it shall be abandoned fn accordance with SPS 383.33,Wis.Admia Code.
NOTES
Two Effluent Fllters to be installed where possible 1 to be installed in ST,and or 1 in pump tank in
order to insure particle size less than or equal to 1/8". Filters should be cleaned once in spring,and once in fall. Also,strainers in sinks in
the building shall be maintained,so that solids and fats are minimized to Flow into system.
A minimum of 2 observation pipes per cell shall be installed. These pipes shall be located approximatety at the end of each celL
The plumber,or county shall see to it that a copy of these plans including this page,maintenance folder,and mainlenance agreement is
given to the homeowner.
This system may contain a dose chamber. If a pump,Float,electncal outage causes the tlose tank to fill,the homeowner should see to it that
the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage.
Contact a pumper or your installer if this problem occurs.
The homeowner is responsible for fortnulating a water conservation plan that will ensure the system is rarely ovedoaded. LE.spread laundry
out over time,not 6 loads in 2 hours,while everybody showere,and uses the toilet,ETC.
CONTINGENCY PLAN FOR COMPONENT FAILURE
A. Septic Tank.Any strudural failure resWting in cracks or leaks in the tank must be wrrected by replacement of the septic tank component.
Leaks in the joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materiais to make joints water-
tight.
B.Outlet Filter.The outlet filter shall be replaced or repaired when it is either no longer capable of preventing the discharge ot particles larger
than 1!S inch or when it has become permanently degraded by cloggfng so as to fnterfere with the design flow out of the septic tank.
C.Dosing chamber and pump.The dosing chamber shall be replaced rf any struc[ural failure is found.Leaks in joints between manhole
risers or covers shall be repaired by replacing faully seals with approved matenals to make joinls water-tight.The pump and controls shall be
replaced when they are no longer capable of functioning according to the design plan.
D.Pressure Distribution Piping. Partial clogging of the distribution network may result in unduty long dosing cycles.The ends of the
distri6ution laterals may be exposed and the threaded end caps removed.The piping can be disconnected on the outlet end of the pump.
The distribution piping may then be back flushed to cleanse any accumulated matter from the piping. It is recommended that the dosing
chamberthen be pumped by a licensed plumber.
E.Soii Absorption Cell.The discharge of sewage or wastewater to the ground surtace is strictly prohibited due to the human health hazard
created by the effluenL All failures created by surface discharge shall immediately be reported to the appropriate county.The pump shall
then be immediately disconnected to prevent further discharge to the ground surface via the soil absorptfon cell.The existing septic tank and
dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorytion cell can be achieved. The
replacement shall be ini6ated onty after any necessary plan approvals have been obtained from the
appropriate plan review authority and the required sanitary permit is obtalned from the county.
Project: ANDERSON/BEIISLE Page 5 of 10
In Ground System Maintenance and Operation Specifications
Service Providers Name Travis Butte�eld Phone 715-634-8176
POWTS Regulator's Name Sawyer County SPIA - Zoning Administration Phone (715) 634-8288
Svstem Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Ave�age 300 gpd Maximum BOD5 30 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 30 mg/L
Soil Absorption Component Size 227.5 ft2 Maximum FOG 10 mg/L
Type of Wastewater pomestic Maximum Fecal Coliform 10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Ins ect and clean as necessa at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test periodicall
Pressure System Laterals should be flushed and pressure tested eve 3 ears
In Ground Inspect for ponding and seepage once every 3 years _
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1 , have a watertight cap
and are secured in as shown in the GeoMat In Ground Component Manual Ver. March 20, 2017.
2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMat In Ground Component
Manual Ver. March 20, 2017. Media is covered with an approved geotextile fabric.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Scarification of basal area is accomplished with a rake or other tool.
5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration.
Lateral Turn-up Detail
6-8" Diameter Finished Threaded Cleanout
Lawn Sprinkler Grade \ '' Plug Or Ball Valve
Box \
�
Lateral Ends at Last Orifice Where
f Long Sweep 90 or Two
��45 Degree Bends Same
Diameter as Lateral
� _ - �, '��' - .
��, ,,:.;_ � � �
Distribution Lateral Lateral Cleanout
96.42 Feet
Project: ANDERSON/BELISLE Page 6 of 10
PAGE�OF'Sl
GRAVITY-DOSED � ��
SEPTIC / PUMP TANK SPECIFICATIONS
,.OVe�,P;� (No Scale)
>,ofl,�m
Building Eler.ln�l niust campty wi�h
tT'Min.m20ftabove COMM16andNEC300
Eslablished Flood Elevation W¢atheryroof Ea9end manhole nser as necessary.
(typicap APProved �unclion BoH
VenlCap �PProveA Locking Manhole
IMPORTANT: � �mwam�ng�aeeinua�ned
Anchor lank(s)as necessary (bpicap
pursuant to SPS 383.43(B)(g) --condwi
4"Mln.or 20 fl above
Established Flood Elevalion
(typical)
�Airtighl Seal-
Finished Grade
Quick�isconnecl
18"Mln.
CAPACITIES @ ���82 gal/in y..- �'YP'�'>
Depth(in) Volume(gal) �
�
A 36.3 429.�7 —*� I,�,�P �—nawo�ea�am�swnn
I HOIe AP{�rovetl Pipe 3 ft mla
B 2.� 23.64 � Liquid sory��i��a
Deptti � Force Main
� Filter*
[C] 3.7 43.73
Alarm - "Install and maintain pursuant
� 9.0 106.38 �B o� ro manufacturer's inswceons.
I C PUMP-OFF
* 51 � PumP �orr ELEVATION= 92_25 ft
Pump Tank Liquid Level= in
° INSIDE BOTTOM
Force Main Diameter= 2 in c°""�`e
B1oJc ELEVATION= 91.50 ft
Force Main Length= 55 ft
3"Appmved Bedding Matenal Benea�h Tank
Force Main Void Volume= 8�97 gai
[C]Total Dose Volume TDV = 43.73 gal/dose
(<0.2X design flow+force main void volume)
Vertical Lift= 6.35 ft
PUMP TANK: SEPTIC TANK(S):
Volume= 602.82 gal Total Volume= 1000 gal
Manufacture ieser Concrete Manufacturer(s): Wieser Concrete Inc
Pump Manufacturer: Zoeller
BN 53 �nstall approved force main filter pursuant to
Pump ModeL �See a��a�,�P�m��Ne� manufacturer's instructions.
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Slmtech
Controls/Alarm Model: Tank Alert EZ
Filter Model: STF-100
Float switches containing mercury are orohibited
GeoMat Distrib�Mon Cell Medla Layout
3 25 Cell Witl[h(k) 2.63 Sidewall to Lateral(k)
Distribution Cell Cross-section Arrangements
_.. . . � . .. . .. . . . �. __._ . . .
_ S
om ne ege
0 Distribution Pipe
GeoMat is wveretl with approved geotextile fabric as per ihe iheir protluct approval.
Distribution Cell Plan View Layout•Typical
325 Ceil Width-A(ft) 70A0 Cell Length-B(ft)
� , .. _ .. . .am2n.
� � � � � �� � �� � ..... �� � � � ��:.
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. . . ... . . .. yp oe sp9ras ell . .
�inichM Cr.�Ac �Y ��v �1`1�V
• DI�LLhOC
I ^ : ' • '-' � � ' ., flat\f11 �.. �ALQt�(SY�
��Co��� 12 -48" -
� ,� -T " mr�le,w,
pipe Aa.�- - �h,• � F,hcie
. . � PiO� 1�__.
�"'��'.. � _ . _. _—. Q '��T
, � , .� , � , z-,,srr�c s3 s�, � � � . � � � � ��—�
� __ __ -- ---- ---_ _ �au�s�
__—NA'i'IVE SOIL-J_ J�_�
� I- --=== - ------- ---_� L�^-naxFwQ
See Cetails on page 4 for number,s¢e,a�spau�g of laterals.
Project: ANDERSON/BELISLE Page 8 oF 10
CHECK BOX AS APPLIC/BLE. CHEGK 00X AS APPLI('ABLE.
� SOIL EVALUATION sc��e: �°=so' �'SYSTEM PAGE90F/O
SITE MAP � � 90 �20 PLOT PLAN�/
PROJECT NAME: �Sz DESIGN FLOW: 7-�0 cPo
TSo/� �r-5�� � Co�c� ��iSIP Attach tlesign flow calculations for commercial plans.
PftOJECTADDRESS: �� �.� Pipe Material/AS fM S/'tan�d����s 384.30-3 8 384.30.5)
NSanilary5ewer. �(
9M SYmbol: � �1� BM Elev�ion: ���� �J FT Farce Man: � ��kD(
BMOescriplbn: I �+� �� S`��P�l ST��
i„a;�,�„o,�,yy IMPORTANT:
Siope G2alent(%) weli Symbd(if appNra6le): p arawin9 an anow Show ground elevafion contours at suifable intefvals.
o(Testetl Mea: on me approprite ke.
d aSon /I-ndCPl�.san ��C� ���IS�G
9 b 3 u�r�-F �l '
y l�c�,�S�.. � wT SYo/6
7�
II /
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a) ��.a s
3) 9g, a S
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� TOTAL DYNAMIC HEAD/FLOW
PUMP PERFORMANCE CURVE PER MINUTE
�
� �
MODELS 53/55/57/59 EFFLUENT AND DEWATERING
0 6 2o MODEL 53/55/57/59
Q
= Feet Meters Gal. Liters
U
� 15 5 1 .5 43 163
} 4 10 3.0 34 129
Q � •a' 15 4.6 19 72
o �897 Shut-off Head: 19.25 ft.(5.9m)
2
5
��� 37/8 � 63116
45/g 11f2-1112NPT
� `
,o Zo a5 o ao so � � �
GALLONS ` 3��e
UTERS 0 80 160 � — i — -�- _!
FLOW PER MINUTE U �
a
� ��
CONSULT FACTORY ; i
�
FOR SPECIAL APPLICATIONS ; !
�
• Variable level float switches availabie. � i
3 Variable level long cycle systems available. I
• Available with special cord lengths of 15', 25', 35' and 50'. i
• Alarm systems available. ! i
,o,ns �
• Duplex systems available. �
i
- _ i �
� - I
� 3 3132
+
_ , I __ SK858
Sin IeSeal Convol Se�ection ustin SELECTION GUIDE
Model Volts Phase Mode Amps Simplex Du lex CSA UL 1. Integral float operated mechanical Switch, n0 extemal COntrol fequired.
M53/55 8 M57/59 tt5 1 Auto 9.7 t — Y Y 2. Single piggybadc variable level float switdi a double piggyback variable level
N53i55 8 N57/59 115 1 Non 9.7 i 2 3 or 4 8 5 Y Y float switch. Refer to FM0477.
• BN53 115 t nuto 9.� ' — Y Y 3. Mechanical altemator"M-Pak° 10-0072 or 10-0075.
` BN57 i�5 1 Auto 9.7 ' — N Y 4. See FM0712 for correct model of Electrical Altemator.
' BE53/57 230 1 Auto 4.8 ` — Y Y
D53155&D57/59 230 1 Auro 4.8 1 — Y Y 5. Variable level control switch 10-0225 used as a control activator, with Electrical
E53l55&E57/59 230 1 Non 4.8 2 3 or 4&5 Y Y Altemator(3)or(4)float system.
'Single piggyback switch included.
L CAUTION
ForinformationonadditanalZcellerproductsrefertocatalogon PggybackVanableLevelFbatSlyi�hes,FM0477; All instatiation of controls. protection dewces and wiring snould be qone by a qualified
ElectricalAltemator,FM0486;MechanicalAltemator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase licensed electrician. All elecvical and safety codes should be followed including the
Simplex Pump ControllAlarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupa6onal Safety and Health Act
(OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
-- MAIL TD: P.O. BOX 16347
Z � I�������\,� Louisville, KY 40256-0347 Manufacturers of..
� �E�O SHIP T0: 3649 Cane Run Road
.\ivo LouisviJle,KY40211-1961 Q��yPU,1IPB,s��E /939�
www.zoeller.com PUMP !O (501) 7�(502)'77�4�-3?q8 PUMP
OO Copyright 2006 Zoeller Co. All rights reserved.
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Office of
Sawyer County Zoning and
Conservation Administration ���`��`,7 �� ��
10610 Main Street, Suite 49 � ���,.��I�,fj ,fa:� /�
Hayward, WI 54843 f �� ���`—�'`�l'�
Tel:��is>634-szag �.... � 0 � ��� �'��
FaY:(715)638-3277 �:��. �
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URL:l�tta://sawyercount�Qov•or� ��,t�r� =�� ;�,;. ,�_
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Email:zonine.sec(n�sawyercoui�ty ov.ora ����'d;,,;;:;�,��,-�,
Toll Free:Courthouse/General Information �`��`�''
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1-877-699-4110
� Sawyer County Zoning and Sanitation "As - Built" Form
Property Owner's Name G S� /1 ���5�� � �(/2/�� �e[ 1 S!{'
Fire Number and Road Name �j��-��c ��,�
Plumbei's Name '���y� �u��U��(�'
Date of Installation �a - i 3 - a voZ o�
County Sanitary Pernlit Number �a'"t ao� —o�� y
12 Digit Parcel Number � Q/`� '8`�/ - � � Y3/O
Description andEIevation ofBenchmark _ ��l �� Suruey �A/'��'
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Tank Manufacturer and Capacity �/i�S� /Uop �o�
Setbaelc-Tanlc to Nearest Lot Line � 3 r
Setbacic-Tanlc to Nearest Well s�
Setback-1'ank to Building o?s�
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Cell Width .S - �,j
Cell Length �v �
Number of Cells �
Setback-Cell to Nearest Lot Line �,o �
Setback-Cell to Nearest Well v� (
Setback-Cell to Building 3s �
Setback-Cell to Navigable Water —
Make and Model of Dispersal Unit (�Po ,'h� �
Make and Model of Filter ��s� C�fD ��3
Make and Model of Pump Cv�;,,,.�,-b r� � �
-Please complete other side -
"As-Built Plot Plan"
Elevation Data
B enchmark / (9 �
Please include the followin •
Building Sewer �_
Tank In �/'9"' � Location of observation and vent pipes
Tank Out � 'o " • Feet of i�isei•s used on tanlc(s)
Dose Tanlc In � Location of benchmark and North arrow
Dose Tank Bottom —T3" � Location of all components
Header or Manifold 3 'f " • Length of pipe between components
Distribution Pipe y'Y" � Number of chamber units in each cell
System Elevation ,��`� " � Location of well, lot lines and road
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