HomeMy WebLinkAbout010-118-00-5700-SAN-2022-193 v�""'"'�'�r Industry Services Division County (�
J�� �� , 4822 Madison Yazds Way �c��.,;' '�� `�
(�E ` Madison,WI 53705 Sanitary PermitNumber(to be filled in by(
t ' P.O.Box 7302 �
�����'� Madison,WI 53707 (9 3� � � s
� Sanitary Permit Application StateTransactionNumber �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit 1
is required prior to obtaining a sanitary pemvt.Note:Application forms for state-0wned POWTS aze submitted to Project Address(if different than mailing a —
the Deparhnent of Safety and Professional Services.Personal information you provide may be used for secondary �
puiposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. ��� (�I
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Property Owner's Mailing Address Property Location
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City,State Zip Code Phone Number ��
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�1 or 2 Family Dwelling-Number ofBedrooms ,3 S r— j � Subdivision Name
Block# �� �-���' �.jt=_cKL-�
�'ublic/Commercial-Describe Use �U•�
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❑State Owned-Describe Use Ov��t CSM Number illage of
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`�' �1ew System �eplacement System �Other Modification to Euisting System(explain) �Additional Pretreatment Unit(explain)
�+-��rk Re - ��c� t�r_.v��
B' ❑EIolding Tank �In-Crround �AAt-Crrade �Mound Individual Site Design Other Type(explain)
(conventional)
C'. ❑Renewal Before �Revision hange of Plumber �I'ransfer to New Owner �st Previous Peanit Number and Date Issued
Expiration �`►�-"�� IO f.Z S- !t l,/
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Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispetsal Area Required(s� Dispersal Area Preposed-(s� System Elevation
h�S`c� • 7 ��� ,e,�;s;i���7Z �c 50 5S' �
Capacity in Total #of Manufacturer
Tank Infoanation Gallons Gallons Units � c��, � 'g �
New Tanks Existing Tanks � � y � a3 � � �
c%� � v� fi C7 P.
Septic or Holding Tank /v�
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Dosing Chamber � �
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Plumber's Name� t Plumber's Signature MP/'vIF'RS Number Business Phone Number
Jeny Rui��xcavating, LLC Q�
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Stone Lake,
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Conditions of ApprovaUReasons for Disapproval
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SA.V1�`(ER COIi�!TY
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Attach W rnmplete plsns for the system and submit to the Connty oNy on paper not leaa than 8 1/2=11 inches in size
NO REFJND�AF�EFi
SBD-6398(R.02/22) ISSUE OF PEfiAA�T O�-� � 3
PAOE 1 OF 4
In-Ground Gfravt�y Pian
Inc�ex � Cc�ver 3heet '
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Pp Z ot 4 Plot Pl�t ex;,�;,,
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P� 4 ot 4 ManagerneRt Plan
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3oN Evduatlon 8� 31ba
RroJ�t N��D�xIP�Elon
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� SOIL EVALUATION S"�'�� '°-40' � SYSTEM PAGE 2 OF
SITE MAP ° � � � PLOT PLAN
PROJECT NAME: �p, DESIGN FLOW: �J5 U cao
�7"�,y� ��tin—�� Attach design flow calculations for commercial plans.
p��qpppE�: 12.�£'-� ��: �,>�t-(� 5 H o•^�'— Pipe Matarial I ASTM Standard(Tablee 384.30-3&384.30-5)
N SenitarySewer y��5c-� �Ff�/ �UC:—
BM gymna: � BM�aveaa,: /OD,v Fr Face Me�n: /
aMoee�nw�. ��;F ��- �o��craT�
Indicros north� I MPORTANT:
Slops G�dierd(%) yye119ym6d(ttappllfsWe): Q arnwlnq•n.�nn Show ground elevafion contoUB Bt eUifable intervals.
a Ta�bd Area: on tne aDDroGrMe Iine.
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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), WfsC. Admin.Code, this system shall
be Considered a human heatth 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 Disaersal Area Oueratina LimRs:
Deaign Flow= �r�v gpd; BODS 5 220 mgL''; TSS <_ 150 mgL''; FOG 5 30 mgL''
Insoection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of System
o nuisance factors(i.e. odors, user complaints, eta)
o mechanicai malfunction (i.e., pumps,valves, switches,floats, etc.)
o meterial fatigue(i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e.,distribution I drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution ceIl prior to dosing
o dosing irregularities- if applicable (i.e., pump re-cycling,float switch settings, etc.)
o electrical components-if applicabie (i.e.,wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure-compare to design spec�ca6on)
o surface discharge of effiuerrt or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tenk(sl shall be pumped by a cert'rfied septage servicing operator licensed under s. 281.48 Wis.
Stats.when the volume of solfds in the tank(s)exceeds one-third(1/3)the iiquid volume of the tank(s)or
as required by tocal ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(sl shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's spec'rfications. A serviang period will always be greater than 12
morrths.
Systom maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report eny component failure or malfunction to:
Name of individual or company: �e;�C'� g :�.c� Phone: 715- �l�f 2- 2�(L `�
Loca1 gwemmerrt unit: S �. Z Phone: 7/�= C. ��I ` �- Z.��
Localgovemmerrtunitaddress: 1G�.(�i �71.�,�,�S�G, 5;,�',-� �(R Z�p: �-c{ � �-( 3
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (t),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.
Continaencv Pian
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.
Reset Pa e
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Real Estate Sawyer County Property �
Property Status: Current
Listing
Today's Date: 8/2/2022 Created On: 2/6/2007 7:55: 17 AM
`m==�
�' Description Updated: 3/12/2021 Ownership Updated: 3/12/2021
T�x ID: ' � 9?13 THOMAS R & CHRISTINE M HAYWARD WI
�� 57'�010-2-41-08-26-515�-184- ��� PATRICK
PIN. O�1570Q
�egaey PIEV: �1€�118C7057t�0 �� Billing Address: Mailing Address:
Map ID: -6.57-59 THOMAS R & CHRISTINE M THOMAS R & CHRISTINE M
Municipality: (010) TOWN OF HAYWARD PATRICK PATRICK
STR: S26 T41N R08W 12588W SOUTH SHORE RD 12588W SOUTH SHORE RD
��� � �����.�.�� ����� ��.�.� �7R�� HAYWARD WI 54843 HAYWARD WI 54843
Recorded Acres: 1.020
Lottery C�aims: 1 Site Address * indicates Private Road
First Dollar: Yes 12588W SOUTH SHORE RD HAYWARD 54843
Waterbody: Round Lake
Zoning: (RRi) Residential/Recreational One property Assessment Updated: 4/18/2022
ESN: 444
2022 Assessment Detail
Code Acres Land Imp.
'� Tax Districts Updated: 2/6/2007 G1-RESIDENTIAL 1.020 281,100 180,100
1 State of Wisconsin
57 Sawyer County 2-Year Comparison 2021 2022 Change
010 Town of Hayward Land: 281,100 281,100 0.0%
572478 Hayward Community School District improved: �,81,9Q0 180,100 -1.0%
001700 Technical College TotaL• 463,000 461,200 -0.4%
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°�+ Recorded Documents Updated: 6/15/2011
0 WARRANTY DEED Property History
Date Recorded: 8/24/2018 414Q39 N/A '
0 TERMINATION OFDECEDENTSINTEREST
Date Recorded: 5/9/2017 406656
m WARRANTY DEED �
Date Recorded: 7/21/1975 152033 262/184
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