HomeMy WebLinkAbout024-110-00-2100-SAN-2022-033 ,����'="-".;:;., Industry Services Division Ca�tY r`
� 4822 Madison Yards Way � • "�
_ ',�S p - M8d1SOri,WI 53705 Sanitary Pemut N er(to be fi(led in by Co.) �
s P.o.soX 7t6z
� Madison,WI 53707-7162 (0,3 9�!�
;,.,
Sanitary Permit Application State Transaction Number �
ln accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the a�propriate govemmental unit d
is required prior ro obtaining a sanitary permit Note:Application forms for state-on+ned POWTS aze submitted to Project Address(if different than mailing address)
the Department af Safety and Professional Senices.Per�onai inforcnatio�you provide may be used for secondary �,�,1 a� �J��� (�,f, �
putposes in accordance with the Privacy La�a�,s.15.04(1}(m),Stats. �`t�� r
I.Application Information—Piease Print All Information
Property Owner's Name Pazcel#
�h.n W i ��r'v W�V �c ' � O/ /��' /�Q'Q Q"� � �
♦
Propecty Owner's Mailing Address Property Location
l p l i l `��` , � � �� �,..�.
Ciry,StaYe Zip Code Phone Number
'i� { �----F���-/ `�.�c 1 �`i`� ' /J6�_�'Section_��
II.Type of Bnilding(check all that apply) Lot r 2 � T' `"� / N R Q� E o
�1 or2FamilyBwelling-1VumberofBedrooms SubdivisionName
stQ�k- �i l�t�Ol:� ��l
�ubiic�Commett,�ial—Describe Use
�ity of
❑State Owned—Describe Use CSR1�Tumber itiage of
�Town of_� �.�;C.J-�`��
III.Type of POWTS Permit:(Check either"New"oc"Replacement"and other applicable on line A. Check one box on line B.Complete line C it
a Iicable.)
`�' �lew System nReplacement System �Other Modification to Esisting Sysiem(explain) ❑Additional Pretreatrnent Unit(e�cptain)
L_l
B� ❑tlolding Tank !n-Ground �At-Grade �Mound Individual Site Design Other Type(explairr)
�(conventional)
C• ❑Renewat Before �Rcvision hange of Plumber �ransfer to New Owner ist Pre�rious Permit Number and Date Issued
Expiration ^�
iV.DispersaU'I'reatment Area and Tank Informatioe:
Design Fiow(gpd) Design Soil Applicaiion Rate(gpcUsf} ITispetsai Area Reyuired(s� Dispersai Area Proposed(s� System Elevation
�0 , �S� 5, 1�
Capacity in Totai ,-of Manufacturer
Tank Infurmation Galions Galions Uniu R � � 'Q L � �
V J �j �n .v;
New Taoks Fcisrin=Tacil:s � � y C u � r. cs
:J rn :n c7� w C7 C.
Sepiic or Holding Tank /^,!�Q oO/'� I �� �C d�'
U lJ lJ � �X^
Dosing Chamber � �
V.Respousibility Statement- I,the undersigned,assume resQonsibitity for inshallation of the POW'TS shown on the attached plans.
Plumber's Name{Print) P ' Si�ature i�11?h�9F'RS Number f3usiness Phone Number
l 7 � — �
Plumber s Address(Strect,City.State,lip Codel
a5 �'u T �'av�-� ��
VL Coun /Department Use Only
�A ro ❑Disapproved Pennit Fee Date lssued Issuing Ageot Signaturc
��J�'v ❑Owner Given Reason for Denial � (�v'� 3 -3./—a,a, ������
Conditions of ApprovaUReasons for Disapproval
_ _ " �s� aa- ��� � ���;��.l���� ��l��,
� ,:.�, � r�:._-- ,
�� � � .�� (%'.1� � ��� �.""�=---- k=�'
`- ` r•�U�7� � � t �,I �,9 A. '�, 1 2�22 i
NO REFUNDS AFT �- ,a� ,�,r,� �
ISSUE OF PERMIT -- � -"�
_.---�
Attach to complete plans for the system and submrt to t Counh�onir on paper not less t n 8 Irz x il iuches in size ;. ,.-� ' '' ''
SAWYER CClJNTY ���
SBD-6398(R.03121) ZONING ADMINISTRATION
PAGE 1 OF 4
in-Ground Gravity Plan � �
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10/12). , ,
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s):_�(��I(� V�� ��Gc_U1,c�{"L+ �J�A���Y� Phone: - -
Owner Address: �,�I l�� 5�. S� �����CtyL�. Th�Zip: �;-r'�'��
Project Address: �i0�� �5�� I'�f�- .
Govt. Lot: 1/4 of 1/4, Section�, T �/ N-R 05 E Q or W �
Township: ��('�y��Q_ �,�-�� County: `��t�.(.�11�-i�,/'"
Project Parcel ID #: ���� ��(� �- �D `- {� �O�
Designer Information
Designer Name: �V(�� �(,t�'1�. Phone: ��S�S-/G�7�
Designer Address:{(1��N�'0l,�L��Id.caS�y�'GQ �ip: �rj�G�;�3
E-mail: G�'1� ;,,.
License Number: ��n�'�!
Remarks:
Signature: Date: �'��r���
Original signature required on each submitted copy.
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' � Septic Tank(s)M�inufacturer:
iN-GROUND �RAVlTY DISPERSAL ARE� `��,, �,_ �, �f
� Unifarm Elevation Trenches with EZ1203HP Bundles Sc�pticTanl<(s)Voli.ime(s):
3-ffi Trench (down-sizing credit)
��-�.�i �.�i ��i 4���i
� �f_� � •L•ifluenl f=ilter M��n �c,turc�r:
�V V!�k_�-.�.--•-- - --� -�...-_..�'�.._. - ` -- ���
Ccaote�xqlc: I �� -min.12" FT(luent Fillt�r M�d�llt: y,�,,,_/ �� ���
Cavi�r — � _' -_� (�Yl�hsd)
soi�cc�vr�i� - I� TYPICAL TRENCH ��__________.__...._..__._.._�___._____.�._.______._____._
� � ,�,
nifn.henr.h- . ° � . CROSS SECTION VIEW
��«,,n, .._� _ .,_ _ - .J`,. : ;;� (No Scale)
(�v�'�`:O�) J� •� • " V . . 0135[RVA'CION PIPC DETAIL.
/ (Nn Scr�la)
p '
GM�- .� . . ir.rnw•'fypo ni •
5ysle:rn FI�vnNnn= (t. - � . siq,c.;ip(luuca) y ��"W'• "(ini,;hud G��ldu
�tyn����� I'rovide minimum 3 fit , (rnitlr.hnd R�;�rnrlad)
SG�'��f�11011 f�C:lWP.CII 11"Cf1CI1CS. 4'�OPVC Pipi�-�- ,,l;• Iop:;odCaver
I np ol pl(��e Ie�Innninrdu (min.1 fnol)
;d oi;d�nvc linishnd�i;idn ,
����i�°-ir.°x e°sioi�� - —
TYPICAL TRL=NCH (Show lor.�lion of inlc�l/ouUcl��ipc:conncr,lion on�If�n vir,w.) �,>>� :��,;��i
:s;;;.,.. ...�..
PLAN V1CW ����:i��������,rn,���:�,._.. ..T. .,:� i��r�w,�������
���� Obsuivuliun pipu shull liu iuetlallud ��N 3udar.a
(No Scale) �d�unclicnibulwaunlwuunils. �` �
Pc�rfUr�ted Laleral on:;c:�v.�iion i�t�,u -�
— (tYC�ic�t) tivr�ia,�) I (tvPir.ap
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�...�.��___ _.� _—_____J g= � ft - -_____ ..�..� W
(�yr����i�
INSTnLL PER TRENCI-1: --- EZ12U3H Bundle a
------- (typfcal) -f�
, 5� 1p-ft bundles @ 50 ft' CISAlunit= ��� fC' (mfd by Inflltratar Systcanis,Inr..)
Inst�all pursuant to mrinufacturor's inshuclfons.
+ 5-ft bundles @ ?_5 fr ElSA/unit= ft'
� ~ = I�ropased E.IS� pr.r trenr,h= �, fl' fdequired Irrfiltration Arr.�a= ���it' Distribution Method:
�
x �„�,,, trenches = F'ropos�d Taial EIS/� _ ��a rt' >���'
RFSET `
PAGE40F4
In-ground Gravity Management Pian
IMPORTANT:
The owner of this in-ground gravity system shali be responsibie fior its perpetuai operation and maintenance pursuant to
requiremenfs of SPS 382-384,�sc.Admin. Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code, this system shall
be considered a human heaith hazard if not maintained in accordance with this approved management pian.
Furthermore, all inspection and maintenance activfies shatl be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc.Admin_ Code. ,
Maximum Disaersat Area OperatinA Limi#s:
Design F(ow= �/S l� gpd; BODS_<22Q mgL"'; TSS <_150 mgL"'; FOG <30 mgL"'
Inspection Checkiist {NSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.}
o mechanical malfunction (i.e., pumps,valves, switches, floats, efc.}
o materiaf fa6gue(i.e., ieaks, breaks, corrosian, etc.)
o solids volume in anaerabic 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 distribufion ceil prior to dosing
o dosing irregularities-if applicable (i.e., pump re-cycling,float switch settings, etc.)
o e(ectrica(components-if applicable(i_e_,wiring, connections, switches, controts, 6mers, alarms, etc.}
o distrib�tion lateral or taterat orifice plugging (measure(ateral distal pressure—compare to design specification)
o surface discharge of effiluent or sewage baek-up into structure served
Maintenance Checkiist MAINTAIN EVERY 3 YEARS {or when necessary)
o Septic and dase tankts)shai! be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats.when the volume of sotids in the tank(s}ezceeds one-third(4/3)the tiquid vo[ume of the tank(s)ar
as required by locai orziinance. Disposal of contents shalf be pursuant ta NR 113,Wisc.Admin.Gode.
o Effluent fiiter(s?shalf be inspected every 3 years and shall be deaneci when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
mon#hs.
System maintenance reports shall be submitted to the proper loca!govemrnent unit in eccordance with
SPS 383.55 Wisc.Admin.Gode. Report any component failure or malfurtction to:
Name of individuai or company: Phone: ���'S,���J7`,�
Locat govemment unit: � ' Phone: ��;������o��
Loca!govemment unit address: ��J`(� ����jf" �' `-�9 1�� ZIP: �J���
Ct/
Any defec6ve part of this system shal{ be repaired, repiaced,ar removed pursuant to SPS 383.51 ('i),Wisc.Admin.
Code. Repair or reptacement of faiied or malfunctioning components shalf comply with SPS 383,Wisc.Admin. Code.
No product fior chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc. Admin_ Code_
Continaencv Plan
!n the event that any failed treatment component of this POWTS cannot 6e repaired, it shalt be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-comptying dispersat component in a pre-determined area of suitable soils.
Svstem Abandonment
(f use of this POWTS is discantinued, it shaft be abandoned in accardance with SPS 383.33,Wisc.Admin. Code.
3/31/22,8:20 AM Real Property Listing Page
Real EState Sawyer County Property �isting Property Status: a,��nr -
Today's Date: 3/31/2022 Created On: 2/6/2007 7:55:39 AM
.�'Description Updated: 8/4/2020 � Ownership Updated: 8/9/2021
__ _- ---� -- - -- -- --- . _----__ ---- ____....__ -- _. .. .____ __- ---___ ___..
Tax ID: 23456 JOHN W&7ANET L STAPLETON PINE ISLAND MN
PIN: 57-024-2-41-05-19-5 15-223-002100
Legacy PIN: 024110002100 Billing Address: Mailing Address:
Ma ID: -1.21 ]OHN W&]ANET L )OHN W&IANET L
Municipality: (024)TOWN OF ROUND LAKE STAPLETON STAPLETON
STR: S19 T41N R05W 2101 11TH ST SE 2101 11TH ST SE
PINE ISLAND MN 55963 PINE ISLAND MN 55963
Description: BIG WOLF ISLAND LOT 21
Recorded Acres: 0.690
Calculated Acres: 0.756 � Site Address *indicates Private Road
.. _------ —----------- ---._-_ ---
Lottery Claims: 0 N/A
First Dollar: No
Waterbody: Moose Lake �--� Property Assessment Updated: 7/18/2019
------------------------- ---_ _ - _ ____ - _
Zoning: (RRl) Residential/Recreational One 2022 Assessment Detail
ESN: 402 Code Acres Land Imp.
G1-RESIDENTIAL 0.690 87,600 0
� Tax Districts Updated: 2/6/2007
_ __�_..---_._..__..__ _ --- - -- _----._. _._.�__
1 State of Wisconsin 2'Year Comparison 2021 2022 C ange
57 Sawyer County �nd: 87,600 87,600 0.0%
024 Town of Round Lake Improved: 0 0 0.0%
572478 Hayward Community School District Total: 87,600 87,600 0.0%
001700 Technical College
+� Recorded Documents Updated: 8/9/2021 �Property History
_.. -- .._____..__.._ �__.__.__ _
_ _. --_._____ ___ � _
0 WARRANTY DEED N/A
Date Recorded: 8/6/2021 433817
0 MAP OF SURVEY
Date Recorded: 1/7/2019 1 41 -
0 QUIT CLAIM DEED
Date Recorded: 12/21/1981 1 143
O NOTE
Date Recorded:
https://tas.sawyercountygov.org//system/frames.asp?uname=Kathy+Marlcs 1/1