HomeMy WebLinkAbout002-940-36-4101-SAN-2020-128r »s.1^I-:V- -Industry Services Division1400 E Washington AveP.O. Box 7162Madison, Wi 53707-7162CnunlySawyerSanitary Permit Number (to be filied in by Co.)Sanitary Permit ApplicationIn accoiUancc witli SPS .183.21(2). Wis, Adin. Code, subini,-.sion of (bis form to llicapptTtpriatcgovemmenlai unitis required pnor to obuiiiiini' a Kinilary permit. Note: Applieiillon lomis for slalc-owncd POWTS arc submitted tothe Dcp-inmcnl of Safety and Pnifessionai Serv iees. Personai infonnalnm you provide may be used for sccondaiyputpiises inaeeordanee with the Privacy Law, s. 15.(N( I Xm). Slats.State Tiaitsaction NumberProject Address (ifdifferent than mailing address)I. Application Informnllon - Please Print All InformationProperty Owner's NameJon B BluugliParcel«002940364101Property Owner's Mailing Address7492 N Higbland RoadCity, StateHayward. WIZip Code34843n. Type of Buildlnt; (check all that apply)IS I or2 Family Dwelling - Numbernf Bcdnxnivs□ Publie/Commetcial - Describe Use _C State Owned - Describe UsePhone Numl)er507-456-5168Property LocationGovt. LajtNE 14, SE 'A. Section 36(circle one)T40N : R09EorWLotHSubdivision NameBlock ftCSM Number24454 X6S52[~~l City ofn Village ofTitwn of Bass Lake111. Type of Permit: (Check only one box on line A. Complete line B If applicable)A,B.□ New Systemn Permit RenewalBefore Expirationn Replaecmeni System H Treatmeni□ Pennil RevisioniTank Replacement Onlyn Change ofPlumberi~l Permit Trartsferlo NewOwnerIV. Type of POWTS Sysleni/Coniponent/Dcvice: (Check all tliat apply)□ Other Modiftcation to Existing System (explain)List Previous Permit Number and Dale Issued92-1210 Non-Prcssuri/cd In-Qmund Q Pressurized In-Ground O At-Grade O Mound > 24 in. of suitable soil D Mound <24 in. of suitable soil□ Holding Tank Q Other Dispcisal Component (explain) D Preircaiment Device (explain)V. Dispersal/Treatment Area information:Design Flow (gpd)600VJ. Tank InfoDesign Soil ApplicationRale(gpdst)0.7Dispersal Area Required (sO900Capacity inGallonsNew TanksExisling TanksTotalGallons#ofUnitsDispersal Area Proposed (sO900 c>-ff wUManufacturerSystem Elevation94.9E S£ USeptic or Holding Tank12601267RasmussenDosing ChamberE.HVil. Rcspotislbility Statement- I, the uiidcrslKned. assume responsibility for Installation of the POWTS shown on the attached plans.Plumber's Name (Print)Jason KuuttuIPlumber's Sign^Plumber's Address (Street. City, State, Zip Code)PO Box 66 Cable. WI 54821MP/MPRS Number675751Business Phone Number715-798-3355VIII. Couutv/DcDiirlmciit Use Onlyj [ 1 Disappivived\ Q Owner Given Reason for DenialPennit FeeWO"D.«>Date IssuedY' 7-^0^0Issuing Agent Signature iIX. C'ondllioiis of Approval/Reasons for DisapprovalORIGINALNO REFUNDS AFTERISSUE OF PERMITJUL 0 2 2D20Attiicli toconiplrtc plaiu lor the system anil submit lu the County only on paper not less than 8 1/2x11 IncSDD-6398(R03/I4)SAWYER COUNTYZONING ADMINISTRATION
PAGE 1 OF 4Pg1 of 4Pg 2 of 4Pg 3 of 4Pg4of4In-Ground Gravity PlanIndex & Cover SheetComponent Manual Design References:Version 2,0, SBD-10705-P (N.01/01. R. 10/12)Index & Cover SheetPlot PlanDispersal Area Cross-Section & Plan ViewManagement PlanAttachments:Enclosures:POWTS Application for ReviewSoil Evaluation Report & Site MapProject Name / DescriptionJon Blough - 4 Bedroom Septic Tank ReplacementOwner Name(s): Jon 8 BloughPhone: 507 .456 .5168Owner Address: 7492 N Highland Road Hayward, WlZip:. 54843Project Address: SameGovt Lot: ^ 1/4 of 1/4, Section 3? , T^O N-R09 E CD or W [3Township: Bass LakeCounty: SawyerProject Parcel ID #: QQ2940364101Designer InformationDesigner Name: J^son Kuettel Phone: 715 .798 .3355Designer Address: PQ Box 66 Cable, WlZip: 54821E-maii: tim@andryras.comI lJl^ rt-MTVi-J i(i: .iin-rov.il suiiip.License Number: 675751Remarks:Signature:Original signalCrefequlred on each submitted copy.Date:
CHECK 0OX AS ap^jcacleCheck sox as applc^le.□ SOIL EVALUATIONSITE MAPPROJECT NAME:Ton' T/Vr-iA iZgpL'4-C.trPROJECT ADDRESS: 7*^*^7 >.1 Ul (g-"NBM Symtm. BM Elevaljon FTBM DescflBlicn: TcP 'SlOBeGradl«nl(%) — WallSymbal(itaBplicaBlel: QbI Tested Area. T 'V//Scale: r = 30'30 4560//////AA/(7 5 n grid)7.5'BSYSTEM page 2 OFPLOT PLANDESIGN FLOWGPOAllacO design flow calculations for commercial plans.(ft4(cate nofin oydrawing an arrowon iho approprJia lina.Pipe Material / ASTM Slandard (Tables 384.30^ & 384.30-5)Sanitary.c;g>«.»r C-H Mo iForce Main: HA /IMPORTANT:Show ground elevation contours al suitable Intervals.O W nJ - '3^ Q - - !&-« O 6.^_'7'-('=?a.VJ (-"ST" iT^X A.^._':„P_0^'=iyo_2GV/o^...; ■ctLp/vu . ^iiT. s>g/rfc Lc7:_/.:Cj/yv jHj/isi.I : Is !sc»' 7^'iLon'ThkW oj-- g/^JC Ot-Nt--5r9tdX.u(^r TtP 100 •.(),.,1I1. -IEjL Jtsm ! «s.i_W'ti.-i..I/t J-0'I ;"b^weuAYet——--/ui PiU/-- ltoA-»tTO tTtisML/^F-CyOO-G□IT-^ I U-JCCy-lSr-c(A'C■pr^'S_vc3.Cs>£feyy£xv-S.ewe4utiietrTSILtW(s.■ , rE>tCCF/dtbj. ''II1 t'ZASAr'vKE/-' jZfeo p/ojZfc-wv; /=i<_7iM-r YO oLto ir^t_7-4rv-I 1-\.ucNt-ico. ofe/i9A''T.e
\l/ \l/18" MIn.(typical)InletApproved Joints withApproved Pipe 3 (t ontoSolid GroundPAGE 3 OF 4TANK SPECIFICATIONS(No Scale)4*0 Vent Pipe>10 (t fromBuildingApprovedVent CapIAirtight Seal12" Min. or2.0ftal)oveEstablished Flood Elevation(typical)Approved Locking Manholewith Warning Label Attached(typical) 4" Min. or 2.0 ft aboveI Established Flood Elevation' 1/(typical)d*\l/ \i/Finished GradeHOLDING TANKVOLUME = gal. d :>•*•. I3" Approved Bedding Material Beneath TankTANK MANUFACTURER:Anchor tank as necessarypursuant to SPS 383.43(8)(g)Ballast Weight = ((cu.ft.tank.vo! x 62.4 Ibs/cu.ft) - Ibs.tank.wt] x 1.5Ballast Weight = [( cu.ft. x 62.4 Ibs/cu.ft) - lbs] x 1.5 = .lbs
Office ofSav^ryer County Zoning Administration10610 Main Street Suite 49Haywai'd, Wiscousin 54843{7l5)634-S238FAX (715)638-3277E-fnidi; Tonanv sec(gBn\weTCQiintVBOv.o> tfTali Fr€Q CourH>ousc/G€n«nl Tntormotion 1*877*699-41 JOSAW\TER COrnXY SAJVITATION DEPARTMENTTEMPORARY EMERGENCY TANK INSTALLATION APPROVALPROPERTY OWNERS NAME: JOATOWN OF:ADDRESS: Im/1I.,a WisconsinLiceased Plumber, authorized by the owner, do hereby acknowledge diat I am receivingtemporary approval to install a septic tank/holding tank without a soil and site evaluation,or existing system evaluation, and private sewage system plan review due to incleraentweather and/or health and/or safety emergency.Further, I acknowledge that a soil and site evaluation, or existing system evaluation, andprivate sewage system plan review will be conducted by the deadline stipulated by thepermit issuing agent, or as soon as weather conditions or circumstances permit. If theprivate sewage system is found to be failing as defined in s. DSPS 381.01 (92), Wise.Aden. Code, corrective measures will be taken as such that the private sewage systemcomplies with all applicable requirements of chapter DSPS. 383, Wis. Adm, Code,within 90 days of this agreement.I flirther acknowledge tliat failure to comply by obtaining all necessary pennits after thedeadline'date may result in the issuing of a citation, under Section 11.3 [2) SanitaryPermits], of the Sawyer County Citation Ordinance.DEADLINE FOR THIS AGREEMENT SHALL BE:Signed:'^4.0Date: ^|Z-T-Iy.D U)Accepted by;Date of temporary emergency approval:Rev. 03/26/13
PAGE 4 OF 4In-ground Gravity Management PlanIMPORTANT:The owner of this in-ground gravity system shall 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, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer inaccordance with SPS 383.52 (3), Wise. Admin. Code.Maximum Dispersal Area Operating Limits:Design Flow = ^00 gp^. bqDs S 220 mgL ^ TSS S150 mgL'^ FOG < 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 I drop boxes)o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)o extent of ponding in distribution ceil prior to dosingo dosing irregularities - if applicable (I.e., pump re-cyciing, float switch settings, etc.)o electrical components - if applicable (l.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. Disposal of contents shall be pursuant to MR 113, Wise. Admin. Code.o Effluent filterfsl shall be inspected every 3 years and shall be cleaned when necessary to remove anyaccumulated solids according to manufacturer's specifications. A servidng 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. Report any component failure or malfunction to:Name of individual or company: Andry Rasmusssn & SonS, IflC Phone: 715-798-3355Local government unit: Sawysr County Zoning Phone: 715-634-8288Local government unit address: 10610 Main St. tf49 Hayward, Wl ^jP: 54843Any 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 vwth SPS 384, Wise. Admin. Code.Contingency 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.Svstem 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: 7/7/2020Property Status: CurrentCreated On: 2/6/2007 7:55:08 AM;':1^ OfwcriDtionUpdated: 7/19/2018OwnershlnUpdated: 11/5/2019Tax ID:4109JON B BLOUGHHAYWARD WIPIN:Legacy PIN:Map ID:57.002-2-40-09-36-4 01-000-000010002940364101,13,1Billlna Address:JON B BLOUGHMflHInq AddressiJON B BLOUGHMunicipality:(002) TOWN OF BASS LAKE7492N HIGHLAND RD7492N HIGHLAND RDHAYWARD WI 54843STR:S36 T40N R09WHAYWARD WI 54843DesCTiptlon:PRT NESE LOT 1 CSM 24/154 #6552Recorded Acres:6.110' Site Address * Indicates Private RoadCaicuiated Acres:6.1127492N HIGHLAND RDHAYWARD 54843Lottery Ciaims:1First Doilar:Yes^ Prnpar+Y SeeeSSmpntUpdated: 6/4/2015Zoning:(RRl) Residential/Recreational One2020 Assessment DetailESN:407CodeAcresLand Imp.? Tax DistrictsGl-RESIDENTIAL6.11020,100 126,000Updated: 2/6/20071State of Wisconsin2-Year Comparison20192020 Change57Sawyer CountyLand;20,10020,100 0.0%002Town of Bass LakeImproved:126,000126,000 0.0%S72478Hayward Community School DistrictTotal:146,100146,100 0.0%001700Technical Clollege• Rernrded Documents Undated: 11/5/2019[S Property HistoryQ WARRANTY DEEDN/ADate Recorded: 11/4/2019420924Q PERSONAL REPRESENTATIVES DEEDDate Recorded: 7/16/2018413333Q DOMICILIARY LETTERDate Recorded: 7/16/2018413332Q WARRANTY DEEDDate Recorded: 11/2/2012381627Q CERTIFIED SURVEY MAPDate Recorded: 1/30/2003mm