HomeMy WebLinkAbout026-939-29-4301-SAN-2022-044 ° '' "' lndustry Services Division County
� � _ 4822 Madison Yards Way ��ic.� �,�
a = Madison,W[53705 Sanitary Permit umber(to be filled in b�Co.)
PS P.O.Box 7162 �
Madison, WI 53707-7162 (�3 C��,.r�� �
Sanitary Permit Application State Transaction Number
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit 1
is required prior to obtaining a sanitary permit.Note Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing address) (7
the Department of Safety and Professional Services.Personal information you provide may be used for secondary �
purposes in accordance with the Privacy Law,s. I�.04(I)(m),Stats. � / �L�� � � � �
I.Application Information—Please Print All Information S� A.1
Property Owner's Name Parcel# (�i� 3�J_� _,t,L��
l�.`� Ga S '�Q hY1 SO V� L I 3
Property Owner's Mailing Address f'roperty Location
qW o Ic�7t� ��� �._
Ciry,S[ate Zip Code Phone Number
i
�p�� �,/i C��v�� � � '/<, S� '/a, Section �
J G
II. ype of Building(check all that apply) Lot# T �� N R 0 / E or
1 or 2 Family Dwelling—Number ofBedrooms
Subdivision Name
Block#
�ublic/Commercial—Describe Use
�Ciry of
�State Owned—Describe Use CSM Number illage of
ToW„of Sw�� (h k e
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.
'�' ew S stem Re lacement S stem ther Modification to Existin S stem es lain Additional Pretreatment Unit ex lain
Y � p Y � g Y� ( P ) ❑ ( p )
B' ❑Holding Tank n-Ground �4t-Grade �Mound Individual Site Design Other Type(explain)
conventional)
r• ❑Renewal Before �Revision hange of Plumber �Transfer to Ncw Owner �st Previous Pemiit Number and Date lssued
Expiration
IV.Dispersal/'I'reatment Area and Tank Information:
Desig�I�(gpd) Design Soil Applicaijon Rate(gpd/s� Dispersal Arca Required(st) Dispersal Area Proposed(s� System Elevation
• � 29 ysz ��. �� - �92.7
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units S, v U ,a, u
New Ta��ks Existing Tanks � c � ` � D R �
0
a U v� � ✓: i�. U a..
Septic or Holding Ta�ik 7So '7�'U ( �7 C S�'
i
Dosing Chamber � �
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/I�1PRS Number Business Phone Number
Dylan Schultz 1516129 715-558-5904
Plumber's Address(Street City,State,Zip Code)
7076N Stone Lake RD, Stone Lake, WI, 548 6
VI.Co n /Department Use Only
�� Permit Fee Date Issued Issuing Agent SignaYure
�Ap ro� d ❑ Disapproved $ �
� '/ � ,,� �� � )
�� ❑Owner Given Reason for Denial L���� 4�- //._ �e2- ���
Conditions of Approval/Reasons for Disapproval
. ��! , �� _.. . �
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��V �� � �� APR 1 1 2022 r.�../�'
--�"'----�
�WYER COUNI'Y
Attach to complete plans for the system and submit to the County only on paper not Iess than 8 trz x 11 inches in size
SBD-6398(R.03/21) NO REFUNDS AFTER
ISSUE OF PERMIT
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): L ��S J ol�nS�►1 Phone: - -
Owner Address: �Yo l07� f�v� �'��S �� Zip; .�yvZ�
Project Address:
Govt. Lot: ��'✓ 1/4 of s� 1/4, Section�, T 3 �1 N-R�E�or W,�
Township: �a��. �h�(� County: s�u y c�
Project Parcel ID#: 2.,9 ( � 3
Designer Information
Designer Name: Dylan Schultz Phone: ��5 _ 558 _ 5904
7076N Stone Lake RD, Stone Lake, WI 54876
Designer Address: Zip:
E-mail: dylanschultzl8@gmail.com , ; , ,l� , ;,,:, , , ,,:,
License Number: 1516129
Remarks:
Si nature: Date: ' �3 � ��
� i � al signa ired on each submitted copy.
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABI.E. ,
❑ SOIL EVALUATION o s`�1e: 40 40 so 80 �SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: ��o ft grid) �Q� DESiGN FLOW: ��G GPD
Attach design flow calculations for commercial plans.
PROJECT ADDRESS: I G Z 7�W P�` l� Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
NSanitary Sewer -S<<^ y6 /
BM S�mbd: � BM Elevation: ��a FT
, � Force Main: /
sM oe��pu«�: l�iu�1 �n f�-�tJeh b�sc o� �Q� o
Slope Gradierri % t�dicate north by IMPORTANT:
( � Weu Symbol(if applicabte): 0 drawing an arrow Show ground elevation contours at suitable intervals.
Of T@sted/Uee: on ihe approprite line.
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Dylan Schultz I
7076N Stone Lake Rd
Stone Lake, WI 54876 I
MPRS 1516129 I
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Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA �,�s-�
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) ��
gal gal gal gal
Effluent Fi�er Manufacturer:
� ol��o�
' Sz�
EfFluent Filter Model#:
min.12"
SOIL COVER (typicaq
t2"
min.trench
depth
�ryP��a�� ��� • ' TYPICAL TRENCH
' • : �: . -� �� �� ��'�.a��•. CROSS SECTION VIEW
��tyP��� .:.,. .: .,. .. � . . (No Scale)
a . a,. . :.
. � ' Provide minimum 3 ft
System Elevation = ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (ryP��9
Install per manufacturers PLAN VIEW
instructions.
(No Scale)
- - - - - ��- - - - - - - - -�� —
���r�����,� — — — — — — — — �
"' A= 3.0 ft
,.. .,
(�� ,■,��i��ar _ — — � °„ ��, � .��„� � r �
� 3 ��t�_
�- r, . , ���� �'.���'� IC2�
(�YP ) �
- - - - - ��- - - - - - - - ��- - - - - — — � D
B = �"� ft G�
m
�ryP���� Quick4 Standard-W Chamber w
INSTALL PER TRENCH: (typ���� �
(mfd by Infiltrator Systems,Inc.) -n
II �� Install pursuant to manufacturer's instructions. �
Quick4 Std-W @ 20 ft� EISA/chamber= ftZ
+ �_ Pairs of end caps @ 6 ft�EISA/pair= � ft2
= Proposed EISA per trench = 2Z� ft2 Required Infiltration Area= �Z� ftZ Distribution Method:
x 2— trenches = Proposed Total EISA = y�Z �tZ G'��'�Y �
PAGE40F4
In-ground Gravity Management Plan �
IMPORTANT:
The owner of this in-ground 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= �6b gpd; BODS <_ 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, eic.)
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 tank(s) 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) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s1 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: �Vl� ��`���7 � Phone: ��s����yOY
Local government unit: � C �— Phone:
�i�- E3 y- 8z�8
Local government unit address: S���'� �� ��'`%W�"�� V� ZIP: �Y��
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.
4/11/22,9:07 AM Real Property Listing Page
Real EStat2 Sawyer County Property Listing Property Status: cu�e�t
Today's Date: 4/11/2022 Created On: 2/6/2007 7:55:49 AM
�Description Updated: 1/1/2007 �Ownership Updated: 12/9/2020
--- --------------___-._----- ------.___--------- -- _
Tax ID: 29193 LUCAS 7]OHNSON ROBERTS WI
PIN: 57-026-2-39-09-29-4 03-000-000010
Legacy PIN: 026939294301 Billing Address: Mailing Address:
Ma ID: .15.1 LUCAS J]OHNSON LUCAS 7 JOHNSON
Municipality: (026)TOWN OF SAND LAKE 940 107TH AVE 940 107TH AVE
STR: S29 T39N R09W ROBERTS WI54023 ROBERTS WI54023
Description: SWSE
Recorded Acres: 40.000 � Site Address *indicates Private Road
------.____.._ _..---��_________ _ _._....�_
Calculated Acres: 37.654 16246W PANK RD STONE LAKE 54876
Lottery Claims: 0
First Dollar: No �::� properly Assessment Updated: 2/6/2007
Zoning: (RRi)Residential/Recreational One �-- �"���------""---�"--"----�---�---
2022 Assessment Detail
ESN: 423 Code Acres Land Imp.
G6-PRODUCRVE FOREST 40.000 60,000 0
� Tax Districts Updated: 2/6/2007
��� -----_______..�.___---------- --- ---------
1 State of Wisconsin 2-Year Comparison 2021 2022 Change
57 Sawyer County tand: 60,000 60,000 0.0%
026 Town of Sand Lake Improved: 0 0 0.0%
572478 Hayward Community School District Total: 60,000 60,000 0.0%
001700 Technical College
•� Recorded Documents Updated: 12/9/2020 �Properly History
------ — — - ------------------------- -- - -- ----
0 TRUSTEES DEED N/A
Date Recorded: 11/16/2020 428039
O QUIT CLAIM DEED
Date Recorded: 4/12/2017 406158
0 WARRANTY DEED
Date Recorded: 8/30/1982 183872 342/408
https://tas.sawyercountygov.org//system/frames.asp?uname=Kathy+Marks ���