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HomeMy WebLinkAbout002-940-36-4201-SAN-2022-055 °•' '" Industry Services Division Counry (J� , _ 4822 Madison Yards Way � �(J' ' , � ; , _' - Madison,WT 53705 Sanitary Permit Nu� (to be filled in b; g = P.O.Box 7162 � {� Madison,WI 53707-7162 ��� �� � � Sanitary Permit Application S�te T�n�`'°°N°mbe` �, In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is reyuired prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing � the DepaRtnent of Safety and Professional Services.Personal information you provide may be used for secondary ( t•e pu�poses in accordance with the Privacy Law,s. 15.04(1)(m),Stats. �'�) L Application Information-Please Print All Information Property Owner's Name Parcel# �' , �� �1�.� Z: �1�,� c� 4� - �D -.��- `t� I Properly Owner's Mailing Address Property Location � W � V�..'(.cY`EJ'- ' �CT' Fiev.rL-oY� City,State Zip Code Phone Number `- �,�i/,.yf) � ✓t !�C� �3 �"� ya, �� y<, Scction �c� 'u-�-�C� 'i. � / II.Type of Building(check all t6at apply) Lot# T `Z� N R �� E or �I or 2 Family Dwelling-Number ofBedrooms � � Subdivision Name Block# �— �ublic/Commercial-Describe Use _ ❑City of ❑State Owned-Describe Use CSM Number illage of .— �Town of �'I�c�J �-�'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.) �� New S stem (-��c, lac;ement S stem ther Modification to Existin S stem ex lain Additional Pretreatment Unit ex lain ❑ Y• IX In'P Y � g Y� l P ) ❑ � P ) L��! �' �llolding Tank �In-Ground �At-Grade �Mound Individual Site Desigm Other Type(explain) (conventional) C• ❑Renewal 6efore �Revision 'hange of Plumber �I'ransfer to New Owner �st Pre�ious Permit Number and Date Issued Expira[ion O�_I�� O O iV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Reyuired(s� Dispersal Area Proposed(s� System F.Ievation � � ` ..j � � �" / i � Capacity in Cotal #of Manufacturer Tank Infortnation Gallons Gallons Units � � o � � New Tanks Existing Tanks '� C v � a� a�i � � °L' o � "' -° — a. U �n v, in v: ::� a. Septic or Holding Tank � � G Z'ti�,/ , � - �'� -�� Dosing Chamber � � � V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb 's ignaturc MP/h1PRS Number Business Phone Number � �7 - � � _� --�lb�' Plumber' ddress(Street,City,State,Zip Code) �l��TG1 J-�l'\.-I-f'��f1�l �1t�- f--t.�• � U:�2!'t5�� �� ��C�' VL C unty/Department Use Only � p�e ❑Disappro�ed Permit Fee Date lssued Issuing Agent Signature ❑Owner Given Reason for Denial $ `�'� `I� Zo �Z-Z '��,�(��'`�(�1�✓'- Conditions of Approval/Reasons for Disapproval .� p � � r '�� �� � �� C s� O� -- �O 1 APR � � 2Q22 ; ,,,: �r.�_-=� i'. . �. ,_� �_ i:l,./I':iI'<ui{�;�`i�;ii;•...,..-.��,:.�i� Attach to complete plans for the system and submit to the County ooly oo paper not less thao 8 Ii2 x 11 inches in sue N���FUNDS AFTER SBD-6398(R.03l21) 1��1��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 8� 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)���'�'C, lG C��i1,��l�.t� �, �-u-�'4.� Phone: - - Owner Address: ��-/(o�1� E-�IGGt�_!'.[P��� l��uYtl�t�, �c.� Zip: �� � Project Address: Govt. Lot: 1/4 of 1/4, Section_��c� , T �C�N-R �-�1 E 0 or W � Township: �L��'� LG��'_ County: ._z,c�t,�-� Project Parcel ID #: �'jD�.—�t..�-�0� -- i..��0/ Designer Information Designer Name:��_�� Phone:��S S�-���� Designer Address: c� �/V Q. Zip: j��� E-mail: _ �`,� License Number: 7�(��� Remarks: Signature: Date: ��- �g--��a ' al signature uired on each submitted copy. ��ner; �e a.� ; �o��-�C. � Ca,-�he���� Z, Lu�zc� �a.u� � �'C o< } �j�Ss l.:�t,�� T'�� :GZ � �l�`� W H��in�-t�"i I�� i�-� Oo o�� ��l- 03�00- t�J��I . - �-c��.��.��;�:�.�t t .�.��. �: ,��:°�� �; �� Y�W 5 E S��� yo }� D�i � ,;; r � � � ,. �,. ��'�!'? � t, �f,,; � ,�l ; �i� ;� �� � ���`�' �j,.= ,;� G- � � ��/ '� �/i/ f �y 1� f ( �''`<'-J� F' �.(i, '-� �i� ��� 1 �� � /� �� v - � / ` '�1s;,_'^<� ' ��'',''�:'�� � �':.� _._ _______ �, ----._.___ �� � /rs ; . ,`-� 2 ,, ,� t,,�' �� j—�---�----t----r f � . � /: `�O ✓'('`" (� � - . ��� f � ��� � ��; ,� ��r._� � . �--�F- �----� ---� ; f`� -s � �; , _ ,� _ s�. �� < _�` ,',j � �—.�_ } �� �i �. `� _ ; � �� I � , � '+ �.- f..�.. �/ Cr�\ �. 1 ��"�. , � ���� O�� � : j � �,421 � 2 A�' �Go��P�► ��P M�N�S Z ti � . �'"f���',' . "=L�,:L, ,'� /�, . � IN-G�OUND GRAVlTY DISPERSAL AREA 5<:����� ���„<<<s�M�nufar.turer: S�i�-c� �- t/�j�%�i����� Uniform Elevation Trenches with EZ1203HP Bundles sc�ptic:ranlc(s)Voli.ime(s): 3-ft Trench (down-sizing credit) • o �- gcil ��41��I qal �43a1 -L•(fluenl f=ilter anufacfurer: _.S'L_�''__�(_.T.,'�_•..,�' --�---� —� _�--._'y-_!�_. �1�,�n �.� �'r� - 7~.Ll.��P Cenl�xlli�r I ���- min.1'l." f_Y(luent Fiil�r Mpdt�l ll' ������Z- � --� ��YPlcal) Cuvi.n � ,�___.�___.�,.�.._..--------------- Sc�i�cc�vr�i� �— � TYf'ICAL TRENCH � _� : ,.,, . IYIIfI.I(F)IICII^ -� '-� � � . CROSS SECTIQN VIEW (�l}�l��l ._'L J p� � ��v�71(::I�� . ._ ��� r'r,` •..• '• .,� (IV� �.rii�IP.) o�3srr�vA-riory �iPc ��rni�. , (No Sc;iiv) 'd V� Sysl�rn Fl�vntl�n =�Sr� � . ,r.row•rvnon� •,�,.W.. �finishudUrudu I�rovicle minimum 3 it Slip C�ip(luoua) + (mulr.hnd K r�!udncp (lyplC�l) ' sep�ration be;iw�cn irenches. ���f�PVC Pipc��-.- +; ;. — lopriuil Cnver I np al pipcl I<�Irrrtninnlu (min.1 fnnl) ;d oi nbuvo(lnishnd�pudo . �n)�i�°-ul„x c,°sir,��� ..._ TYPICAL Tf�ENCI-I (Show lor,�(ion c�f inln�/rn�Unl pipc conner.lion on�I��nvicw.) ���u�� :��,;��i PLAN VIEVV Anr.hnun�Dovir.n�_. .���� '''��" -Inliltr,diun ���� Ohsurvaliuri pip�t:;h;�ll lm innl�dlud 5���`��:�� (No Scale) �d�uncliunbulwuunlwciurtils. �� ��w--"',• ' Perforated Lat�ral o�r.;erv��tirn,n�p� -� _ (typic�l) (�vr�ic:�q (�vnic:al) ____._- _ _ . .��"-:���_�---�"1 _ �_____ _ -_ ... -_ ��_ ___ ____ _._.___ _ ._- ;..,�.�.- -.,_.-:_- .:,�._�.� .._. . _ _ -_._-- .- _�._. __.-_ .._ ._ _. __ _ � � -- - �._.__�_=.. _______._. _ ____ _ --.: =_ =_�=.--� :-_�_�_=� - . t �.__ _ .__.. __---____ ___.-- - _ ___.._ _. � -- ---�__�_ _ ____ .._.. . ' L-�—�__-=._--�._ __ ._ ----.� _._ ._._ ...._ .�f __ ---. ._�__.. __ .._. ._ .__ _. -- -:_ _ _-_ _- — -_ __.=_ J c�y�,�`:`"��> f�t'I � _.._ _._--- g- � ft ._�___.__ _..�_.�_ .__� w c�yn��7i� INSTnI_L PER TRENCI-I: -- EZ12031-I Bundle � ______._w�____ __....� (typicalJ -P. !� 10-ft bundles @ 50 fP CISAlunit= 3 S � ft' (mfd by Inflllrilor 5ysternr,Iru:.) Install pursuant to manufacturor's InsUucl(ons. + 5-ft bundles @ ?_5 ff' EISAlunit= ft' ^M = I�rop�sed E.IS� p�r trench= 3�O fit' Ftr,quired Infillr�tion Are�a= �'� ft' Distributian Methad: x _,�,w lrenches = f�raposed Toi�l FIS/� = ,��o� it' ��-�,r-;�,� �,����, �; � RFSET ` PAGE � OF 4 In-ground Gravity Management Ptan . iMPORTANT: The owner of this in-ground gravrty system shali be responsibie 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 shalf be considered a human health hazard i#not maintained in accordance with this approved management pian. Furthermore, al! inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with 5PS 383.52 (3),Wisc.Admin. Code. , Ma�cimum Disaersal Area Oaeratina Limits: Design Ftow= L/�,j� gpd; BODS<_220 mgL"'; TSS �150 mgL"'; FOG 5 30 mgL"' inspection Checkiist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e_ odors, user complaints, etc.) o mechanical malfunc6on (i.e., pumps,valves, switches, floats, etc.} o materiaf fatigue(i.e., leaks, breaks, corrosian, etc.} o solids volume in anaer�bic treatrnent tank(s)and any distribution appurtenance(s) (i.e., distribution/drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibi#ed activities, etc.} o extent of ponding in distribution cell prior to dasing o dosing irregularities-if applicable (i_e., pump re-cycling, float switch settings, etc.} o e[ectrica[components-if appficabfe(i.e.,wiring, connections, switches, cantrols, timers, atarms, etc.} o distribution latera!or laterai orifice ptugging (measure lateral distat pressure-compare to design specificafian) o surtace ciischarge of effluent or sewage baek-up into struc#ure served lVlainfenance Checklis# MAINTAIN EVERY 3 YEARS {or when necessary) o Septic and dose tank(s)shall be pumped by a certified septage servicing operatar iicensed under s. 281.48 Wis. Stats.when the votume o#sofids in tFie tank(s}exceeds one-third{1!3)the liquid volume of the tank(s)or as required by locaf ordinance. Disposal af contents shalf be pursuant to NR 113,Wisc.Admin. Code. o Effluent fiiter(sl shalt 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 mon#hs. System maintertance reports shall be submitted to the proper locat government uni#in accordance with SPS 383.55 Wisc. Admin. Code. Report any componenfi faiture or matfuncfian to: Name ofi individuai or company: �1..��, �C v�Q,�- Phone:��S �J`> O "��0��� � t �- Local govemment unit: ., ��� ��1�- Phone:�����,��"� ���' Loca! govemment unit address: I(��`� l�t�'�-�-� L1�y����(1-r� ZIP: �J�� Any defective part of this system shall be repaired, repEaced, ar removed pursuant to SPS 383.51 {1),Wisc.Admin. Code. Repair or replacement of faifed or malfunctioning components shall compiy with SPS 383,Wisc.Admin. Code. No product fior chemica(ar physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384,Wisc.Admin. Code. Continqencv Ptan tn the event that any failed treatment component of this POWTS eannot be repaired, it shat! be replaced pursuant to a plan submittsd to the appropriate agency for review and approva(. A failed in-ground dispersal component may be abandoned and replaced by a code-cornpiying dispersal component in a pre-determined area of suitable soiis. Svstem Abandonment tf use of this POWTS is discontinued, it shall be abandoned in accardance with SPS 383.33,Wsc.Admin. Code. � �� p,�:s�,�� � - Soil ProFile Sheet- � � � Owner: L Soil Tester: C.�, � System Elcva on: z�d Rate: � � �� Systern Range:�Y�t� �`� , < < � � . � o . --(oo.c� lo .... .... � _... .... -`?'9•36 r r----�--- •••• •••• _9 .a(a c--�_ �(`� .S g � :::: :::: �- :_:: :::: . .� � :::: :::: � �'g .... .... -.- -... ��8. �3 ... .... �' . . �� ... .... � . _ --:: :::: � �6. S � ::::- :.:: ,� :::: .. . , 5'� . .. ... ---. .... .... .... _�'S 73 � .:.. ---• ,� .__. .._. .... ---� - ...... ..:... ._..._ .._... ...... ...... �s � � � .7 � .... .... r � ..._ .... _9K 3�� . :..: :::: � �/ �Y .. .' �9�• t6 � .. ._ .. N � .. .. _ �Y ob �-- � :::: :::: � __:: _:� � � :-:: :::: � � � . . .... .... � .... .... .... .... .. .. .. .. , .. .. , � �3 ...... ...... �3 ' ..._.. ...... �+-3 . � . .... .... ,�3 . . � :::: :::: :::: :::: � :::: :::: I . . �? .... .... � .... .... .... .... .... ._ .. - � . r R r :::: :::� -�r.r� f ..:: :::: -9�� 3� ::: :::� _ �r.o6 . ...... ...._. .._... .._... ...... ...... . ...---...... ...... ...... ...... ...... �� gy .... .... ...... ...... ...._. ...... ..... ...... ...... .---.. _..... ...._. ..... ...... � � . - � ............ ...... ...... ...... ..._.. ...... ...... ..---. ...... ...... .----. � ...... ...... ..._.. ._._.. ..... ...... 86 ..... .....: ..... ..._.. ..... ...... 4/17/22,5:35 PM Novus-Wisconsin Access rev. 13.1108 , Real Estate Sawyer County Properly Listing Properly Status:Cur�ent Today's Date:4/17/2022 Created On: 2/6/2007 7:55:08�AM . �'Description Updated:4/9/2020 � Ownership Updated:4/14/2021 Tax ID: 4115 ROBERT C&CATHERINE Z IUKAS HAYWARD WI PIN: 57-002-2-40-09-36-4 02-000-000010 Legacy PIN: 002940364201 Biiling Address: Mailing Address: Map ID: .14.1 ROBERT C&CATHERINE Z ROBERT C&CATHERINE Z Municipality: (002)TOWN OF BASS LAKE LUKAS LUKAS STR: 536 T40N R09W 14680W HIGHLAND RD 14680W HIGHLAND RD Description: NWSE HAYWARD WI 54843 HAYWARD WI 54843 Recorded Acres: 40.000 Lottery Claims: 1 � Site Address *indicates Private Road First Dollar: Yes 14680W HIGHLAND RD HAYWARD 54843 Zoning: (RRl)Residential/Recreational One ESN: 407 .,�..� property Assessment Updated:9/13/2012 2022 Assessment Detail � Tax Districts Updated: 2/6/2007 Code Acres Land Imp. 1 State of Wisconsin Gl-RESIDENTIAL 1.000 14,000 164,200 57 Sawyer County G6-PRODUCTIVE FOREST 39.000 66,300 0 002 Town of Bass Lake 572478 Hayward Community School District 2-Year Comparison 2021 2022 Change 001700 Technical College Land: 80,300 80,300 0.0% Improved: 164,200 164,200 0.0% . Recorded Documents Updated: 4/14/2021 Total: 244,500 244,500 0.0% O WARRANTY DEED Date Recorded: 3/25/2021 430762 (� O TRUSTEES DEED "U='Property History Date Recorded: 3/27/2002 298999 N/A l I ' i i I I https://tas.sawyercountygov.org/Access/master.asp �/� !4".�.j � e(M . ..,{ � , Y!'; � ' � ,ly � 1 i..J � �� an r 4 � /�, ��i�� � . ✓ f �LT: � .y f'� � . y ;,+,.�j # �.r, ��,,,,//�� � �.�''�"•� i'� • 7 x�x S� yy,l� .'�,e,� _ yro^� - .L�'� , ,t'�� 'Fy ', y- �f=:" .�s- ,.� f 1 f � �...����i.��,r •!�'+'# -q� �+'.�.�y�` tic'�A:� �',�,;� ,,�Nr#� �`^ � f°�,'�: ,: < :. , tr �'' , . �+'- r,a s.fi ! s , ✓ AT �" � ,►,7►' . ..�.."'lk�c� .} '`. ..,w�. 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POWTS -:���-�% INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION a-� - 6� Personai information you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village [J�Town of: State Plan Transaction ID#: M��s�f' �}--C�n��.�..�5 �� � Insp BM Elev: BM Description: Parcel Tax No: Iv�.o' � e�-�� oD.� ���-q Y� --3b- Y� I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic •� �,, �'�� •� aD � � Benchmark �pQ o� Dosing Aeration Bldg. Sewer � Holding St/Ht Inlet - TANK SETBACK INFORMATION St/Ht Outlet �q y TANKTO P/L WELL BLDG AIRINTA�KE ROAD �-4fttet- .ST� T� ,rSY � Septic �},�.5` �- ` fi�-` .}-„�-1 NA �S.Bgt� o��— .3b� Dosing NA Installation Contour Aeration NA Header/Man. �j6.�' Holding Dist. Pipe PUMP 1 SIPHON INFORMATION infiltrative s.,� � Surface Manufacturer Demand Final Grade Modei Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W t L � 76� #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P I L Bldg Well Waters °� G ❑ Chamber Model Number: � EZFIow CELL TO �- ^- � ❑ Mound o Other - - - - — -- -- ___ -- - DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifoltl Distribution Pipe(s) X Hole Size X Hole Observation Pipes� Length Dia Length Dia Spac Spacing ❑Yes ❑ No SOIL COVER �Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center , Cell Edges Topsoil _ � 0 Yes ❑ No ❑Yes ❑ Na COMMENTS: (Include code discrepancies, persons present,etc.) S�- LS'T_ oa-_ �o l ���,.s���.J` S�s�a � Plan revision required?❑Yes❑ No �1 �l � � -� � �'� � � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�DITI�NAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA: �oZ--6'SS� ��E����' . 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