HomeMy WebLinkAbout024-110-00-5400-SAN-2022-034 ��t�'='-"_;- Industry Services Division Counry
- 4822 Madison Yards Way '
,,` _�=p - Madison,WI 53705 Sanitary Pemut Nvmb r o be filled in by Co.)
= P.O.Box 7162 �.
_ Madison,WI 53707-7162 �3 Gl D� � L,
Sanitary Permit Application State Transaction Number
lo accondance with SPS 383.2 i(2),W is.Adm.Code,submission of this form to the appropriate gaverttmental imit
is required prior Yo obfaining a sanitary permit.Note_Application forms for state-ocvned POWTS are submitted to Project Addres (if diffemnt than mailing address)
the Departrnent of Safety aud Professional Senices.Personal information you provide may be used for secondary Cjn w Q(,� %���-� L},� (�,�
purposes in accordance with the Privacy La�v,s.15.04{1)(m),Stats.
..i�J r•-E �
I.Application Information-Please Print All Information
Property Owner's Name Parcel#
�� � �i ��-; .'�f 6G�n - l�� -�O-- �'' ,
Property Ow r's Mailing A ress Property Locarian
�\ ��J`' � �6uer.tor—
City, tate Zip Code Phone Number
� �� � --i�,� �Ka, Se�teon�_
II.Type of Bv ng(cheek all that apply) Lo�� T N R E or
�1 or2FamilyDwelling-NumberofBedrooms -�j'� Subdi��sionName
-3 � k3�y �-���� z�ta-►'�,�
sio�k�
❑Public/Commen:ial-Describe Use
�- ❑City of
❑State Owned-Descnbe Use CSM Number illage oF
� �Toa��n of I'�U�l�t.p'�- �-f.L�l+�-�
III.Type of POWTS Permit:(Check either"New"or"Replaceme�t"and other appiicable on line A. Check one boz on line B.Complete line C i1
a licable.)
A.
e�v System �Replacement System �ther ModiFication to Esisting System(e�cplain) �Additional Pretreatment Unit(explain)
LI
B' ❑Holding Tank �in-Ground �At-Grade �Mound [ndi��idual Site Design Other Type(expiain)
(conventional)
C- ❑Renewal Before �Rerision hange of Plumber �iransfer to New Owner �st Previous Pennit Number and Date Issued
Eapiration —
IV.DispersaUTreatment Area and Tank Information:
Design h�(gpd) Design Soil Appiication Rate(gpcUsE} I?ispers�(Area Reyuired(sfl Dispersal Area Proposed(s� Syst�evation �
(J , � � ,v
Capacity in Total #of Manufacturer
y
1�ank Information Gallons Gallons Units R � v �„ �
New"Tanks Existing Tanks � o y � v p � �
c: V cn y cn �x. C7 a
Septic or Holding Tank �/��� f �'
W�
DosingChamber /1f� �n�/� l ��f1L/� � �
U V tl� V 1 w
V.Responsibi6tY Statement- I,the andersigned,assume responsibility for instal[ation of the POWTS shown on the attached plans.
Piumber's Name(Print) Plumber's Simaturc MPiMPRS Number Business Phone Number
�Gc1� 7 �� �`� ��
Plumber's.4ddress(Street,City,State,Zip Codel
C4 � 1 !� �.�r�-��-�tc��u��-. � � `," , '
VI.Cou ty/Department Use Only
� ro ❑Disapproved Petmit Fee Date Issued Issuing Agent Signature
� 5C/ ao
❑Owner Given Reason for Denial (,�O� � 3(-�
Conditions of ApprovaURcasons for Disapproval ^,_,,--,:-----�r-^�,
��i:=�. :;.
_... __. � .- �- n,, '—' ' -_—_',t 't
Cs� �-� — 0 Ig �.'�
A ����, �a�R � � �c�2 �� .
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Attach to complete plans for t6e system and sobmit to t6e Countv onlv on er not less than 812 x I1 inc6es in sue
NO�RE�U V��S AFTER
SBD-6398(R.03/21) ISSUE OF PEAMIT
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan -
Index & Cover Sheet -
Component Manua!Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10/12). , .
Pg 1 of 5 fndex & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s):��1i�,[�G �Jh���Jt-s� i�1; �-l'nQ.�?'� Phone: - -
Owner Address: r' i c�;,.1 Zip: ��r
vV�� �R � r�� r� m hrrn�_, ��� . ��
Project Address: ��n�� �,�� ��Q. ,
Govt. Lot: .1/4 of 1/4, Section��, T�N-R�E ❑or W�
Township: �CI1�� �G�-�� County: �,u�C�,��
Project Parcei ID#: 4���—1 L 4 J �Q�S�0�
Designer Information
Designer Name: �- t��'1 �'�Q�C1� Phone: ��5�`��
Designer Address: �D�`��7/1�1 ��Q�c��(lil�,Q �a-�'k--l� Zip: ���
E-mail: ���4��a,���-�;.: .;�;�,;,,:
License Number: `��g'.�J��
Remarks:
.._r�
Si nature: =�J' Date: �I � �L ��`�
_ 9
Original gnature required on each submitted copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
min.12" TYPICAL TRENCH
(ypical)
soi�covER CROSS SECTION VIEW
,2„
min.Vench (No Scale)
de pth
(typlcal) <
�---. - , — - �o .. . .e'a' .a
f 34
(typicap , ° Provide minimum 3 ft
+ a
a ° separation between trenches.
System Elevation = �,� ft
(typical) �
Quick4 Standard-W
wl End Cap observation Pipe
(typical) (Show location of inlet/outlet pipe connection on plan view.) (typlcal) TYPICAL TRENCH
Install per manufacturers
��Sc����io�s. PLAN VIEW
(No Scale)
- - - - - �� - - - - - - - -�j� - - - -��r�r����r�r��+��x���+���r�
f��� e�������,�r���l���r�!,
rt
I` I o� I . ` a �I A= 3.0ft
�Cr���+���i�i�s&a{�iGil�rii�i�tl�i�� — — — — —�� — — — — — — — ��— — — — e�it�"tt�iA����iir���tk��t�� �tYPical)
— - - — — — — -- — — �
' - a = 1� ft - I D
r -
(typical) Quick4 Standard-W Chamber m
INSTALL PER TRENCH: (rypica�) W
(mfd by Infiltrator Systems,Inc.) O
Install pursuant to manufacturer's instructions.
� Quick4 Std-W @ 20 ft� EISA/chamber= _�� ft2 TI
+ �_ Pairs of end caps @ 6 ftz EISA/pair= �i ft2 �
= Proposed EISA per trench= y�� ftZ Required Infiltration Area= ��ftz Distribution Method:
x � trenches = Proposed Total EISA = 7_� ttZ r�� � .
�. T ..�
PAGE40F5
GRAVITY-DOSED �
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"PJ Vent Pipe
>10 ft from
Building Electncal mus[comply with
12"Min.or 2.0 ft above SPS 316 and NEC 300
Established Flood Elevation Extend manhole riser as necessary.
(typical) W ealherproof
Approved Junclion Box
Venl Cap Approved Locking Manhole
IMPORTANT: I with Waming Label Attached
Anchor tank(s)as necessary ' (tYP'��)
�Conduit
pursuant to SPS 383.43(8)(g) a°Min.or 2.0 ft above
Established Flood Elevation
(typical)
�Airlighl Seal '
Finished Grade �
" duick Disconnecl
18"Min.
CAPACITIES @ ��'?� gal/in % e . . � � ° �'yP'���
a. �
Depth (in) Volume (gal)
A 1 p� ( 3 I.3.y * � I Weep �Approved Joints with
Hole Approved Pipe 3 ft onto
g 2.0 33� � A II Solid Ground
(typical)
[c] �. 3 �a . � �
_Alarm
� (�. O ` D� �� B I�—On
f ��� PUMP-OFF
P"'"p ELEVATION = � 7�2� ft
*Pump Tank Liquid Level = � �o in ; �—Off °
�
° INSIDE BOTTOM
Force Main Diameter = � in Concrete
B1ack ELEVATION = 7�'33 ft
6 .
Force Main Length = I�� ft 3"Approved Bedding Material Benealh Tank
Force Main Void Volume = ,2,2,� gal
[C] Total Dose Volume TDV = �� gal/dose
(<0.2X design flow+force main void volume)
Vertical Lift = �� ��� ft
PUMP TANK: SEPTIC TANK(S):
Volume = �0� gal W�����'b��-m� � al
Total Volume = � �� g
Manufacturer: �'" `��� ��""^�� Manufacturer(s): w� �-S-�s" C��)
Pump Manufacturer: �`�
Install approved effluent filter at the septic tank outlet
Pump Model: l�3 (See attached pumR�uNe.> immediately upstream of the pump tank inlet.
Controls/Alarm Manufacturer: SSE I��no�b�S Filter Manufacturer: ��e-�Co Q�� -�'��
Controls/Alarm Modet:
Filter Model: �� ��a,Z
Float switches containinq mercury are prohibited.
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PAGE40F4
in-ground Dosed-Gravity Management Plan �
IMPORTANT:
The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SPS 382-384, Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc. Admin. Code, this
system shall be 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 in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= '� � � gpd; BODS 5 220 mgL-'; TSS <_ 150 mgL-'; FOG <_ 30 mgL"'
Inspection Checklist INSPECT 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, 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 dosing
o 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 served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tankls)shalf be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. whe�the volume of solids in the tank(s)exceeds one-third (113)the liquid volume of the tank(s)or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
o Effluent filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc.Admin. Code. Report any component failure or malfunction to:
Name of individual or company: �,�,1� ��41�� `� Phone: / ��5���r�=�
Local government uniY. � Phone: ?/b�—(o�?�1,t� ��
Local government unit address: Q `U • ��-t�`{C. t�G ZIP: ��(� ��
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc.Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin. Code.
Continqencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall 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-complying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
3/31/22,8:20 AM Real Properry Listing Page —
Real Estate Sawyer County Property �isting Property Status: Current �
Today's Date: 3/31/2022 Created On: 2/6/2007 7:55:39 AM
�'Description Updated: il/17/2014 � Ownership Updated: 12/14/2020
_----------------------------------------------- ---------------------- ..-- ----------------- __ -
Tax ID: 23489 PHILIP G&SHELBY M BARNARD MINONG WI
PIN: 57-024-2-41-05-19-5 15-223-005400
Legacy PIN: 024110005400 Billing Address: Mailing Address:
Ma ID: -1.54 PHILIP G&SHELBY M PHILIP G 8�SHELBY M
Municipality: (024)TOWN OF ROUND LAKE BARNARD BARNARD
STR: S19 T41N R05W W7597 OSTROM RD W7597 OSTROM RD
MINONG WI 54859 MINONG WI 54859
Description: BIG WOLF ISLAND LOT 54
Recorded Acres: 0.570
� Site Address *indicates Private Road
Calculated Acres: 0.574 _._----_._- _---_---__�_�—._.__-�- _
----- _. _
Lottery Claims: 0 N/A
First Dollar: No
Zoning: (RRS) Residential/Recreational One � Property Assessment Updated: 6/11/2007
—--_�_�——_--- ____--_ - - -_--- __ _
ESN: 402 2022 Assessment Detail
Code Acres Land Imp.
� Tax Districts Updated: 2/6/2007 GS-RESIDENTIAL 0.570 10,000 0
._ - -- ---._...._ _ - _ ------ -------- -
1 State of Wisconsin
57 Sawyer County Z'Year Comparison 2021 2022 Change
024 Town of Round Lake �nd: 10,000 10,000 0.0%
572478 Hayward Community School District Improved: 0 0 0.0%
001700 Technical College Total: 10,000 10,000 0.0%
i� Recorded Documents _ ` Updated_ 12/14/2020 -
�------------- ---___ _ �Property History
0 WARRANTY DEED _—.---.____— _---.. ----__
Date Recorded: il/24/2020 428262 N/A
O WARRANTY DEED
Date Recorded: 8/14/2015 397185
O ORDER
Date Recorded: 1/21/2015 394082
0 TERMINATION OF DECEDENTS INTEREST
Date Recorded: 10/2/2014 392524
� WARRANTY DEED
Date Recorded: 6/5/1973 144195
https://tas.sawyercountygov.org//system/frames.asp?uname=Kathy+Marks 1/1