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Home My WebLink About024-741-20-1211-SAN-2020-160y'iii'l'l,'.V ^'« ;Induslry Services Division1400 E Washington AveP.O. Box 7162Madison. WI 53707-7162CountySacu^e/-iiumSanitary Permit Nuiflber (to be filled in by Co.)Sanitary Permit Applicationin aceordiineo wiih SI'S 383.21(2), Wts. Adm. Cixle, MiliimssiDii ol'lliis ibnii Id llie j|iprDprialc governmental unitis required prior lo obuiitiing a sanitary pcnnil. Note: Application fonns Ibr stale-owned POWTS are submitted tothe Department of Safety and Professional Services. Personal inlimnation you provide may be used for secondarypurposes in accordance with Ihe Privacy latw, s. I5.Q4( I Km). Stats.Slate Transaction NumberI. Application Information - Please Print All InformationProject Address (if dilVerenl than mailing address)6dool(ntbu\CProperty Owner's Namen^omas Cs (4-- 6n^t( P-^v'. frus^Parcel#Property Owner's Mailing AdtlressCity, StaleZip Code^rf-311. Type wBuiltling (check all that apply)01 or 2 I'amily Dwelling - Number of Ucdmoms [_D Piibiicc'Coinmercial - Describe l!seD State Owned - Describe UsePhone NumberLot #l'ro|wrty Locationijovt. LotF fi/U/ w, Section 2^,ri Xcitcleone)T H! N: R ISubdivision NameBlock#CSM Number□ City ofD Village ofS'Town of pOCmt^III. Type of Permit: (Check only one hex on line A. Complete line B If applicable)A.D New SystemD Keplacement System^TreatmeniHMBB^T'ank Keplacetncnt OnlyD Other Modification to Existing System (explain)B.D Pcnnit RenewalBefore ExpirationD Permit RevisionD Change of Plumbern Pennil Transfer to NewOwnerList Previous Permit Number and Dale Issuedm-o<<8 ^ -g|i( -77IV. Tvne of POWTS System/Componcnt/Dcvlcci (Check all that apply'B^on-Pressuri/etl in-Oround D Pressurized lii-(iround D Al-Ontde D Mounrl > 24 in. of.suitable soil D Mound < 24 in. ofsuitable soilD Molding l ank D Otlier Dis|)ersal Component (explain) D PrelreaUncnt Device (explain)V. Dispersal/Treatment Area Information:Design Flow (gpd)(SVDesign Soil Application Rate(gpdsOr -7Dispersal Area Required (st)2.( ^9Dispersal Area Piupojed (sf)Systan Elevation9/-V'tVI. Tank InfoCajiacity inGallonslolalGallons«ofUnitsManufacturerPrefabConcreteSitcCon-dclcurisFiberlGass01New I'ank.sHxisilng TanksSeplic.or Hdiling TankIGO(riosiiip ClvuiiberVII. Respimslhilily Stntcnicilt- I, the undersigned, nsstnne rcspoiislNlil.v.for installalion of the POVVI'S shown on Ihe ntlaclicd plans.^timber's Name (Print)PluniK-r's SignatoMIVMHCS NumberBusiness Phone NumberPlui ^r's A<!drey^(Strcvl, City, Stale, Zip Code)0 ■ 80^ 6 c SHSz^VIM. CrMinly/Dcpartment Use OnlyB-Xp^nlcc□ Disapproveilu ijwnerrnven neascnPermit fee' u liwnerriiveii KcasonIX. Conjjliotis of i^proval/Rcasons for DisapprovalDate IssuedIssuing Agent SignatureNO REFUNDS AFTERISSUE OF PERMITAiiacli Id cunipti'ie plans for rlio system uiiil suliinll to tliu County duly on paper not less tlian 8 1/2 x 11 InchiSBD-6398(R. OH/14)2028ca\a/yer countyZONING administration INDEX SHEETS FOR POWTSPROJECT NAME: Bujel T^at^ NO. liO^^OWNER: n~hQrU^ C,. **- |4. Trus'hADDRESS: (0^3^^ M bt\JCl4cLytiyAr/^PHONE: HS'-'4(fZ -PROJECT ADDRESS: i\(fflO\A) B^iooLoit^ UXi\eB^pla(!cwieA4W (Sof'- OerificeifCeifl ^LEGAL DESCRIPTION: f^-o^ ^7uJ"Tbujfi o(^ dou^d LaX<e.PARCEL NUMBER: mU-^^1 ~Zo-jZ/l1. INDEX SHEET2. PLOT PLAN3. SEPTIC TANK CROSS-SECTION4. CELL LAYOUT & CROSS-SECTION5. SOIL EVALUATION6. SOIL TESTER PLOT PLAN7. SYSTEM ELEV. VERIFICATION FORM8. SEPTIC SYSTEM MANAGEMENT PLANPLUMBERS SIGNATUREDATEMR# U"75-7sr/POWTS COMPONENT MANUAL # \blQS-P Sc£.LB'« c "meu.AjbSitJeW^tUrtvwii^Se-^7>A. ^ "'ZOr-encc -h'/^7h^ ^/£>SS'9 iDfv^ lyilyi^s~7Siy.sis-i^/pSi^ysR C^.^ ia)/3coajs/-</o-i.i-l'H-2^-12,(1TTUyf^ Ri=:pui.cey>IB^U^10 w BoWojink Li') •1/)IS7-/A V/7P /C>ph-cP ^Tsy=>c>r^i£yQ>Pi f^^yi i£lSY ^ ££-prJC auria-T± 9^-3 '^^^hr/sTP/'^ S/sr^i^ ?Ay^'E-jgUgf-t^iAS i '3.7^/<.j:/U - 9s-,iZ'._" otKT--t [sl51S\^jlfzezo i^S-Buii-f' JIIL/01/2G23/''^HD 12:43 ?M Andry Rasmussen & SoFAX Ko. 7157383470Office ofSawyer County Zoning Administration1O610 Mam Street Suite 49Hayward, Wisconsin 54843pI5)6J4-g28SFAXC7!3)638-3277P. 001/001h~>-7i■?E-motI: zoning settaMwvereountvgov.orBToll Frco Courthoatc/Oeneral Information 1-877-699-4110'^vxvVSAWYER COUNTY SANITATION DEPARTMENTTEMPORARY EMERGENCY TANK INSTALLATION APPROVALPROPERTY OWNERSNAMEinptyX ^TOWN OF: ^OU-Ad LaI^ADDRESS:I, JRfi^ Qaimxss^ .aWisQommLicensed Plumber, authorized by the owner, do hereby acknowledge that I am receivingtemporary approval to iustaJl a septic tank/holding tank without a soil and site evaluation,or existing system evaluation, and private sewage system plan review due to inclementweather 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,Adm. 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 tUs agreement.I further acknowledge that failure to comply by obtaining all necessary permits after thedeadline date may result in the issuing of a citation, under Section 11.3 [2J SanittnyFermirs], of the Sawyer County Citation Ordinance.AGREEMENT SHALL BE2^-z^Signed:Date:CTctiv. I, urdAccepted by:^ ^Date of temporary emergency approval; 0~7lZ)( IRev. 03/26/13 SEPTICC..0S3 .-.hu SPEC! TI CP. T10 3H" Scrt.-tOP'/C itlSP.prpr 6 " HIM. A30VE G.'A03,(c.pt)Cuher. inlt-t" 'fr\iU\\\o\e. tr bari'td IFINISHED GRADELIAPPROVEDPIPE 3'ONTO SOLIDSOIL-APPROVED gfeETfrS-OR/i^LTERHFC. C)\r^COmodel ? PTt)92,2-3" A??R(yVED BEDDING UNDER TANKSPECIFICATIONS3EPT3C ^TfiJtIK MANUFACTURER:TANK SI3E5.' SEPTIC gAL.approvedmanholeW/ Leck:4n. w'■18"I NLET\\kiN.— nrTT—J.•4" HIN.NOTES; 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 Malntalner inaccordance with SPS 383.52 (3), Wise. Admin. Code.Maximum Dispersal Area Operating Limits:Design Flow = TyOO gpd; BOD® S 220 mgL ^ TSS S150 mgL'^; FOG S 30 mgL 'Inspection Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo nuisance factors (/.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, ete.)o electrical components - if applicable (/.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 fllterfsl shall be inspected every 3 years and shall be cleaned 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. Report any component failure or malfunction to:Name of individual or company: Andry Rasmussen & Sons, Inc Phone: 715-798-3355Local government unit: Sawyer County Zoning Phone: 715-634-8288Local government unit address: 10610 Main St. #49 Hayward, Wl 2IP: 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 with SPS 384, Wise. Admin. Code.Contlnoencv 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. . 1i7I;%01/20?�:/WED 12: 43 PM Andry hasmu5sen & S� FAX No, ?1�7�8��70 P. 001/001 � � � � � r� ��% . : �� PY �� -��- � .- � �� f�� `;. � ot��e �� ,�°'°'�; Saw er Coun Zoni�ct A.dmx�xs��ra�xo�. �� , � � Y �Y � � ;. �; �� 106�0�ail�Stzeet Su�te 49 1�.��y Haywazd,Wxscomsiz�54843 � ��a� CQ +l (715)634-8288 �'\/ �,,� �r�I� PA7C(7I5)638-3277 � e� y�Q �1� xtivw.s�w��D nkYu�¢av prK �fq, �� E-mail:�o�lia7�.sec{�sewvercountvatov orA / o v,'"', Toll k'rcc�ourthouae/Ceneral a�form�Hon x-877�99-4I10 Jj� _ �L ��1�L w, ' �/c�-+ V� ' �r�s�g`� . 0 �,�.� �c�,��t�yF � ��Zp � �� i��ry�:� SAWYEIt COUNT'Y SANYTATION TI�PARTIVIENT �.� � ��xoz�x��rcx x.�avz��s�r.a��xxo�v �x:��xov�, ��za��xxavv�r�xsrra��:�o� � �o�nna '��1 . Towzv O�: �,o t��G�. �.L� ADDRESS: � 1(q�b W ��e��iw� l��e. , t-��t�V'�i W.i Z, ��` ��n ,a Wisco�aszn Lxcensed Plumber,authorized by the owner, do hereby acluiowledge tbat Z a�a recexva�og te�po.rary appzaval to iustall a s��tic ta.nk.�holding tank wiChout a soil and site eva�uation, oz e�istixxg syste�evaluation,and�rivate sewage system plan review due to iu�c�eme�at weatk�ez�a�d/oz'�ea�tk�,at�d/or safety emergency. Further,I acknowledge that a soil and site evaluation,or c�isting sysCem evaluation, and private sewage systez�a p�ax�zevxew wi�.be conducted by the deadline sti�ulated by the p�rmit issuing agent,or as soon as weatl�ex coz�dztzons vz circumstances�ermit. If'the �rivate sewage system is fou�.d to be�a��ng as de�ned in s.DSPS 381.01 (92),Wisc. A,d�. Code,corre.�tive measures will be taken as such tb.at tbe px�vate sewage system cozxxplzes with a11 ap�Iicable rec�uirements of chaptex TaS�S. 3$3,W�s. A.d�,. Code, w�i#�im 90 days a�tk��s�greement. � I fiu-hlzer ackn�wledge tlast�a��uxe to covap�y by obtaining all nec�ssary�ermits after the deadliue date may result i17.t�e issui�.g o�a cztatzo�,ut�dez Section 11.3 [2) Sanitary Permits�, o�t�e Sawyer County Citation Ordinat�.ce. DEA �' � .A.G�EMENT SHALL BE: !�/'�'� °�� D . Signed: � � Date: � �� . ^ Accepted by Date of tem�orary enaerge�.cy appxoval: f7�(a� /�a-� Rev. 03/26/13 � � '� �l �1�� ' �� i n(t �'t 7, ►-;j� ;%;,r, VV1�Q..� ��7. 7t� �/,v��G/; '�_.' �,��^ �-�,c,\� :�• 1 � '-��.�; L'�'�:._ 1_. �N,�1.c��g ��'� �L S Y�>.3 �,�.a.� � ; �,� � � �ic / 'c�14;�: /=�1.dC/ � �i r'�(A � ScdLc �/ ' - J � � - �____ �t r�� l/y �'1p 7�I l ^I�7,;�, �' __._ — , � _" ��:..`/`��: �/�.,:;�e�+ �,, ;�,� ,% -v� , '�� L a�- � �..�., I,;,�; , , �==- � � . .� ___ :- �. '� ---- " Ti��/k ��Pc.��tt�.�-�;� „ ��j�� - 1 I �.�;0 �rJ �� _ ti . �-� !�%%� � , . C�h�,�J j i �� , ( . � L'X/�<✓� � �R,� I�Jr`�'70P.3T'�--1'�r,^'r � � �� ,s��i�k � `t'v�/ � L-'�r�,v% D C 0 R ' � � / � j�' ;,;�� "v�'ni 9;'.�_"r " I , � � �' � .� , � EL CV �J'FpTJC o u7L,CT � . iS,oP^d: y� � �/JR��✓Fi=.13 � ' �,.�l� �,�... �% f 9s 3 '`,t , �� ;�� LL�i G�,,sn��e SXsr��, � ` y,� ,,. �. 9i �o, ,�i Q�� / /.�� ,,` /, r j' �C=�" � / ,L�r,�b/C3U�2.c,� ( , �.'S':c- ' l �� i j \� _ _ '� ��`�_-__----�_., , i i� � , � . � _- ...w . � ��`\ � /� � � � . �,, � `�,� �`'��.�� . � �� /�'' ��Y�' � � �i�`E-� 't�t- /`�� ,. ti,� � � . • � r S ',' � / ` S .��Z,d�� ♦ �� e �.,,1_�p Jc�} �``� � �� '7 -`'�---_____..__ -";"""""`r PRIVATE ONSITE WASTE TREATMENT county .,. :l � oa = SYSTEMS Sawyer ��,� PS ( POWTS) ` ,� ��`"' ' ,` INSPECTION REPORT Sanitary Permit No: ' Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� \�� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: ��_� � �.�� \ ��-�. ��.� �--�� Insp BM Elev: BM Description: Parcel Tax No: '��;�;. �v �� `�;...��',�� • ��aS'� C:'a`�--?�-1\-a.�-- ��\\ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � �,�,��_,�,, ��,� Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St I Ht Outlet TANK TO P/L WELL BLDG vENTro ROAD Dt inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P�L Bldg Well Waters ❑ AG ° Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other DISTRIBUTION SYSTEM x Pressure Systems Only C -r— � pO — X Hole Size X Hole Observation Pipes ! Header/Manifold Distribution Pi e s � Length _ _ Dia_ 1 Length Dia Spac ' Spacing ❑Yes ❑ No � SOIL COVER Depth Over Depth Over �—Depth of Seeded/Sodded Mulched � Cell Center Cell Edges ! Topsoil _ ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) '�c:: �\._._.,_�� `x�1 c�� ^-e_, � `��`is?E-s--' �`��. �x7 G��e_ �c: c.,� Me,�.`��e�.� �=� S � e.._x`-� tl o� �-'�=�`� '� 7/��c�-�c3� C'•��/� �'��o--C�e�'-�+ C-%c�\•�1 �I Plan revision required?❑Yes 0 No � � 1 �aa i f �/ �� I 1�� `'` r Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS AN� SKETCH . �AN!TARY PERM!T NUMBER �.� •-1�0 // :.��-t� ��LV'�-, n-� ,�,- �;,�� ' �k �� ' S�, y�, \�bu 0 a , �S-� � ,�� __�` ��( C.�,��;�c.�,� � � ��,:� j "•�'�,�s�„-�,. h,� � -�,�. ..� � � �r �, �� , �.. �... *,��p' � .{ ,,�;�' � �' �: �,`� � �; 1..g ,��. x" s � ` , , ` . �.+�' . t � , ' ��`�� r .�` (,�:,� � " - ` t � _ ,, a'SC:' �-a,.�1��!� �� 1�"+►�+[:� �' • '�"��'c,� } ��;. �'.+ +r�;; w±. ia t t�•T�"�t ,. �iifal �4� � ��..a'}abK as'�,r �# r�i�r��';. �jf�� ,�4 `� �cs� ' � �, sl3� si i�� '�Y y��'�'ii �"� '�` � �L7f y� 'i • �., :.. �l J6�'' •'i� � �,� �a!�j�s. # #�a,ir=" �,��.��- ,�', h' ��ae. �� f' � ��r��,�r` �` r��; � ' _ , e, ��. � � , ., � ,,,� ,/�4 -�'�F��„�F _ ,,,al�3�.,��.� �' '�` '`� �� !,� � _ �'�'� .� .`'�� •�r`�;.a��' '`� ,�� f �' . � �� . r c= �r.��.,� �e .��- ..,.a �rr�` `�`�'" ��5 .� �.�'il��f�� ::-'�'j°` i"��'�� -� �,�.: ��*' :• '� r��+"�'� � 3^'--'a�.�d " .. � . .�„ '�� .� ..��a;.�` i4.� � w, _ �.�j� �,�;K -, t�^> x�, �:�,� �'^` JY.. �� r/J r ��+��f .- x r, f�.1+►� �.��' . ,'t�. •Sr; �,�e�r � J �_' *� ��#�.+ �' �Y��' '9F.� �"�'� . .: � �� ` ��*�"�,t1lk^' .,:+ /�^ �',.��k �' ' �' . � Y'yir'�'iM� �. . �'�„ �' '�..�. � � .�,tT" �r �� ,;�� :, a' aa�ys.. ih' . -� . ic� �� ,JrM`r`��,.w�.�i.�;'��!� t1�V �.,, ��.< n� � :l��l x.r:,�'an' s �.� ' & '''� E.. pY'�+��` �.' 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', `, • �� "�ry . � , - �� k t �Y.. �A�� €� �:t• #�� . ►� -Y�� '� gi. ^.,'x S; •�' �' - sE�,s'�.Y �^ .✓�g� i, i: �f • ' � Real�EState Sawyer County Property Listing Property Status: Current Today's Date: 7/1/2020 Created On: 2/6/2007 7:55:43 AM • -� Description Updated: 7/21/2017 �"' Ownership Updated: 2/6/2007 . Tax ID: 25631 THOMAS C&DONNA H BUGEL REVOCABLE HAYWARD WI PIN: 57-024-2-41-07-20-102-000-000110 TRUST Legacy PIN: 024741201211 Map ID: •.2.11 Billina Address: Mailina Address: Municipality: (024)TOWN OF ROUND LAKE THOMAS C&DONNA H BUGEL THOMAS C&DONNA H BUGEL STR: S20 T41N R07W REVOCABLE TRUST REVOCABLE TRUST 10839N DOVE LN 10839N DOVE LN Description: PRT NWNE,W 200'SOUTH OF LAKE HAYWARD WI 54843 HAYWARD WI 54843 Recorded Acres: 0.230 Calculated Acres: 0.970 Lottery Claims: 0 ¢� Site Address * indicates Private Road First Dollar: Yes 11610W BOBOLINK LN * HAYWARD 54843 , Waterbody: Burns Lake Zoning: (F-1)Forestry One � Property Assessment Updated: 7/16/2019 (RRl)Residential/Recreational One 2020 Assessment Detail ESN: 404 Code Acres Land Imp. G1-RESIDENTIAL 0.230 77,300 77,800 p Tax Districts Updated: 2/6/2007 1 State of Wisconsin 2-Year Comparison 2019 2020 Change 57 Sawyer County Land: 77,300 77,300 0.0% 024 Town of Round Lake Improved: 77,800 77,800 0.0% 572478 Hayward Community School District Total: 155,100 155,100 0.0% 001700 Technical College > Recorded Documents Updated: 8/8/2007 t'�Property History - WARRANTY DEED N/A Date Recorded: 2/28/2005 32881{? WARRANTY DEED Date Recorded: 2/28/2005 3288�9 WARRANTY DEED Date Recorded: ll/15/2000 2&7777 722/278 QUIT CLAIM DEED Date Recorded: 1/6/1986 198538 383/270 WARRANTY DEED Date Recorded: 7/5/1977 160085 283/63