HomeMy WebLinkAbout002-940-23-5213-SAN-2020-254hS. '\',sIndustry Services Division1400 E Washinglon AveP.O. Box7l62Madison, Wl 53707-7162Sanitary Permit ApplicationIn uccunJancc wiili SI'S 383.21(2). Wis Adin. Ctxlc, submission ol'iliis lorm lo Ihc approprioie governmental unitis required pnor to oblaiiiing u siiiiilary permit Note Application I'onns for state-owned TOWTS arc submitted tothe Dcpanmcnt of Safety and I'nil'cssinnal Services. Personal mlbrmation you provide may be used for secondarypunxises in accordance with the I'nvacv Law, s 15.04(1 Km). StatsApplication Enformatinn - Please Print All InformationPropeijy- Owner's NameCity. StateProperfy Ov^ier's Mailing Address .kv.,L; <II. Type of Building (check all that apply)GJj^or 2 family Dwelling - Number of Bedrooms,Zip CodeD Public/Commercial - Describe UseD .Stale Owned - Describe UsePhone NumberLot#Block#CSM Number^70\1111.Type of Permit: (Check only one box on line A. Complete line B if applicable)County'e^ilSanitary Pertnii Number (to be filled in by Co.)State 'I'ransaciion NumberProject Address (ifdifferent than mailing address)Parcel tfProperty IxxiationpA-.Govt. LotSection(circle one)T L\ r)N: R ^ Eor^Subdivision Nome□ City of„D Village of^Town of {\. 5 ^ L-^I^C&ID Replacement SystemQ Treatment/Holding Tank Replacement OnlyQ Other Modification to Existing System (explain)B.D Permit RenewalBefore ExpirationD Permit RevisionD Change of PlumberD Permit Transfer to NewOwnerList Previous Permit Number and Date IssuedIV. Tvnc of I'OWTS Svstcm/C'iininoncnt/Devicc: (Check all that apply[Jlf^on.Prossurired In-Ground □ Pressuri/cd In-Ground □ Al-Grade □ Mound >24 in. of suitable soil □ Mound <24 in, of suitable soilD I iolding Tank D Other Dispersal Component (explain) D Prelreatment Device (explain)V. Dispersal/Treatment .Area Information;Design Flow{gpd)Mk.9Design Soil Application Rate(gpdsODispersal Area Required (sf)7 roDispersal Area Proposed (sf)System ElevationVi. Tank InfoCupaclly inGallonsTotalGallons#ofUnitsManufactureruiSte CondetcurtslPasticNew TonkaExisting Tanks1 1£ uSteel-SIii; tpSeptic or Holding Tank\,9 0O\0 30\ALfosing Chamber1VII. Responsibility Statement- 1, the undersigned, auume/fespal»ibility tor installation at the POW'T^s^wn on the attached plans.Pluipbgr's Name (Print)iMyriim,(^v-r (9vI'lumber's Siih.nlui4P/)MPR.S Number3Business Phone NumberPlumber's Address (Street, City, Slate. Zip C^e) . . ^ ,OlVIII. County/Department Use Only.ppfOVciD DisapprovedD Owner Given Reason for DenialPermit feeDate Issued10- Q-Issuing Agent SignaluroIX. Conditions of Approval/Reasons for Disapprovaltl'AtUch m compleU pUn for lb« tyiirm and submiI ta the County only on paper notOCi 0 6 2020SBD-6398{R. 08/14)SAWYER COUNT .ZONINQ AOMIhMSTRAi -ON
PAGE 1 OF 4In-Ground Gravity PlanIndex & Cover SheetComponent Manual Design References:Version 2.0. SBD-ia705-P (N.01/01. R. 10/12)Pg1 of 4Pg2of4Pg3of4Pg4of4Index & Cover SheetPlot PlanDispersal Area Cross-Section & Plan ViewManagement PlanAttachments:Enclosures:POWTS Application for ReviewSoil Evaluation Report & Site MapProject Name I DescriptionOwner Name(s): _ 3£LLPhone:Owner Address: JKAX Alt 56 / M Zip:Project Address: S L, ^ /,>✓"Govt. Lot: K 1 /4 of 1/4, Section . T VON-R ^ E EH or W |ZTownship: _Project Parcel ID #: O I 3County:rDesigner Name:Designer InformationPhone: ^^5 - 4- fDesigner Address: ff-r iL/fC ^^ntyytri/r Zlp:5Y^0LE-mail: Ppr c :(.rLicense Number: ^ j~ 3Remarks:This space reserved for approval stamp.Signature:/AaTsignature required onOriginafsignature required on each submitted copy.Date:
CHECK BOX A3 APPUCABLE.□ SOIL EVALUATIONSITE MAPPROJECT NAME:Scale: 1" = SO-SO 4560PROJECT ADDRESS:BM Symbol:BM Desciiption:St<^a Gradient (%)oltesledArea:A7.5'CHECK BOX AS APPUCABLE.E] SYSTEMPLOT PLANPAGE 2 OFDESIGN FLOW:QPD^-f- I. o/BM Bevatlon:' OI ^ DC, AFTAttach design flow calculations for commercial plans.Pipe K^ateriat / ASTM Stan^id (Tatjles 364.30^ & 364.30-5)Sanllajy Sewer f A *^0.^ ^ C—/Eoroe Mah:Wdl Symbol (If oppllcabfe): QIndicme nonh bydrawing on orrowon the oppfoprtto lino.IMPORTANT:Show ground elevation contours at sultatile Intervals.rT
IN-GROUND DOSED-GRAVITY DISPERSAL AREAUniform Elevation Trenches with Quick4 Standard-W Chambers3-ft Trench (down-sizing credit)SOIL COVERirmin. frcnchdeptn(lyftealiQuick4 Standard-Ww/ End Cap/— (typical]. min. 12"(lyptcal)34* 1(lypical)\ • 0/System Elevation = L(typical)(Show location of inlet / outlet pipe connection on plan view.)TYPICAL TRENCHCROSS SECTION VIEW(No Scale)Provide minimum 3 ftseparation between tranches.ObseivaSon(typical)Install per manufacturers/ Instructions.— ^-VA = 3.0 ft(typical)TYPICAL TRENCHPLAN VIEW(No Scale)INSTALL PER TRENCH:Quick4 Sfd-W @ 20 EISA/chamber(typical)Pairs of end caps @ 6 ft' EISA/pair == Proposed EISA per trench =^Quick4 Standard-W Chamtjer(lypical)(mid by Infillralor Systems. Ii>c.)Install pursuit (o manufacturer's insttuctbns,Required Infiilration Area = '7t>^ ft'trenches = Proposed Total EISA =75?"Distribution Method:
PAGE 4 OF 4In-ground Gravity Management PlanIMPORTANT:The owner of this in-ground gravity system shail be responsible for its perpetual operation and maintenance pursuant torequirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shallbe considered a human health hazard if not maintained in accordance with this approved management plan.Furthermore, ail inspection and maintenance activities shall be performed by a registered POWTS Maintalner inaccordance with SPS 383.52 (3), Wise. Admin. Code.Maximum Dispersal Area Operating Limits:Design Flow = gpd; BOD5 S 220 mgL ^ TSS S150 mgL ^ FOG S 30 mgL*^Inspection Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo nuisance factors {i.e. odors, user complaints, etc.)o mechanical malfunction {i.e., pumps, valves, switches, floats, etc.)o material fatigue {i.e., leaks, breaks, corrosion, etc.)o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)o neglect or improper use {i.e., exceeding design capacities, prohibited activities, etc.)o extent of ponding in distribution cell prior to dosingo dosing irregularities - if applicable {i.e., pump re-cycling, float switch settings, etc.)o electrical components - if applicable {i.e., wiring, connections, switches, controls, timers, alarms, etc.)o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)o surface discharge of effluent or sewage back-up into structure servedMaintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)o Septic and dose tankfst shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.Stats, when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) oras required by local ordinance. Disposai of contents shall be pursuant to MR 113, Wise. Admin. Code.o Effluent fllterfst shall be inspected every 3 years and shall be deaned when necessary to remove anyaccumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12months.System maintenance reports shall be submitted to the proper local government unit In accordance withSPS 383.55 Wise. Admin. Code. Reportvany component faiiure or malfunction to:Name of individual or company: Phone: '7 (5^ H ((> f \Localgovemmentunit: CtX Phone:Local govemment unit address: /VU>.. 4/" \Ji- .^inz\P\Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin.Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code.No product for chemical or physical restoration of the POWTS may be used unless approved by the department inaccordance with SPS 384, Wise. Admin. Code.Continqencv PlanIn the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant toa plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may beabandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.System AbandonmentIf use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code.
Real Estate Sawyer County Property ListingToday's Date: 10/9/2020Property Status: CurrentCreated On: 2/6/2007 7:55:07 AMDescriptionUpdated: 9/14/2020Tax ID:3600PIN:57-002-2-40-09-23-5 05-002-000130Legacy PIN:002940235213Map ID::2.13Municipality:(002) TOWN OF BASS LAKESTR:S23 T40N R09WDescription:PRT GOVT LOT 2 LOT 1 CSM 27/52#7013Recorded Acres:0.782Calculated Acres:0.818Lottery Claims:0Hrst Dollar:NOWateitody:Grindstone LakeZoning;(RRl) Residential/Recreational OneESN:406■47 Tax DistrictsUpdated: 2/6/20071State of Wisconsin57Sawyer County002Town of Bass Lake572478Hayward Community School District001700Technical CollegeRecorded DocumentsWARRANTY DEEDDate Recorded: 8/31/2020426074CERTIFIED SURVEY MAPDate Recorded: 6/2/2005330789QUIT CLAIM DEEDDate Recorded: 4/19/2005QUITCLAIM DEEDDate Recorded: 12/11/2002306190WARRANTY DEEDDate Recorded: 2/26/1999^ OwnershipUpdated: 9/14/2020DAVID R & KIMBERLY S MAASST PAUL MNBilling Address: Mailing Address:DAVID R & KIMBERLY S MAAS DAVID R & KIMBERLY S MAAS1428 MISSISSIPPI RIVER BLVD S 1428 MISSISSIPPI RIVER BLVD SSr PAUL MN 55116 ST PAUL MN 55116Site Address * Indicates Private RoadN/AlJ Property AssesnnentUpdated: 9/13/20122020 Assessment DetailCodeAcresLandImp.Gl-RESIDENTIAL0.782312,0000.2-Year Comparison20192020ChangeLand:312,000312,0000.0%Improved:000.0%Total:312,000312,0000.0%EB Property HistoryUpdated: 9/14/2020N/A329803 WD664/281 QCD329803274738
'""'''"'"'"%; PRIVATE ONSITE WASTE TREATMENT county
, ;;
���� a SYSTEMS SaWyeT
;:��SP$ :'� ( POWTS)
ry `-?/,
' �''�� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION (� ��L�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 1�.04(1 (m)]
Permit Hoider's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
._1 v,, ,�c.;,=5 ���.55 �-�o--k�
Insp BM Elev: BM Description: Parcel Tax No:
`,�c:,; c�; P�._.\ �� �-y� `J�'�S S\�j `F�.�.�-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �.,�,��� �\��,� C�c � Benchmark -c�:,� \ \`c 1�\ . \"Z
Dosing �;� SetS 3 �`1 l0 3 �`i
Aeration Bldg. Sewer c�;'ia,
Holding St/Ht Inlet �j� �(,
TANK SETBACK INFORMATION St I Ht Outlet �j 7 �a.�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic 3��t N � ��` NA Dt Bottom �I�--�1`'�
Dosing NA Installation
Contour
Aeration NA Header/Man. �j�7 �,U
Holding Dist. Pipe I
PUMP I SIPHON INFORMATION �nfiltrative
c
Surface �C ��C-
Manufacturer `��\�� Demand Final Grade
Model Number �s� GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters � G � Chamber Model Number:
❑ EZFIow
CELL TO �� '� � ❑ Mound o Other �� �� �-�
�- '� _�_..��-- --
DISTRIBUTION SYSTEM X Pressure Systems Only
-- - -
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia�Length Dia Spac � _ Spacing ❑Yes ❑No
SOIL COVER _ ___
Depth Over Depth Over � Depth of Seeded I Sodded Mulched
Cell Center � Cell Edges Topsoil _ ❑Yes ❑ No , ❑Yes ❑ No
COMMENTS: (Include code discrepancies,persons present,etc.)
}� L.:�\� �; �:r-^-e_ c-, .�.��c�.:�� . S\�`� �r�-� �-��.l
'�L��� G c..�c=\\_
�v5�.�-� :,.�� -,,,5��L`e-z. �� �s i a�;a c�
Plan revision required?❑Yes❑ No 1I � � �� ��G ,�=� -----� 1 ,�� 1� �
��� �--- ------
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITAAY PERMIT NIJMBER: ��' a'S�'I
�\\ _ .
\ \\ �� .
�
: (� �i6�
. �\ (6 �
,�
�
;
�;� _
' S„
�, -
�
.
r \� �c�—
. � � �
����
, �; ���'�
�;' �
� �
��3�9/�. �
/C Y �
� s;��'�? S�
� 3 ro� ( ��
4
� C�c�, �
����
/���_
��-a° _
�� :-��.��� �� ��,°�