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HomeMy WebLinkAbout022-738-17-3405-SAN-2022-219 �;'' ' ' '�� Department of Safety c°°°ty � �'� � - & Professional Services, � � - �, a - Sanitary Pern t Number(to be filled in by C �_ . Industry Services Division �3 q a o 8 R� y Sanitary Permit Application State Transaction Number � n,` In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit � 1`-� is requircd prior to obtaini�g a sauitary permit.Notc:Applicarion forms for statc-0wned POWTS azc submittcd to Projcct Address(if diffcrent than mailing a � the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary ,g��.}�� �d�ry i� pucposes in accordance with the Privacy Law,s. I5.04(1)(m),Stats. I.Application Iaformation-Piease Priet All Information � $Q� Property Owncr's Namc Pazcd# a ow o2., Property Owner's ailing Addr s Property Location Q Gov[.Lot City,State Zip Code Phone Number SL � -�—'/.,�'/., Section��_— _� II.Type of Building(check all that apply) Lot# T. N R E or W �I or 2 Family Dwelling-Number ofBedrooms_? �r Subdivision Name � �7 Block#f ❑Public/Comme�ial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 17 20 �529 `�T�„�"�` �ad i sSo� IiI.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete liae C if a licable. A. �New System ❑ Replacement System ❑ Other Modilication to Existing System(explain) ❑ Additional Pretreatment Unit(explain) B' ❑Holding Tank ,�,In-Ground ❑ At-Grade gn yp ( xp ) ❑ Mound ❑ Individual Site Desi ❑Other T e e lain (convcntional) C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner is�t Previous Permit Number and Date Issued Lxpiration �—' IV.DispersaUTreatment Area aod Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/st� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation . y� �ly s.ss' Capacity in Total #of Manufacturer Ga(lons Gallons Units d V� � Tank Information � � �, New Tanks Existing Tanks � o c� � y p ^ `�'� a U v� ti cn i+. C7 C. Septic or Holding Tank Q/�O "� b�O }� � v� OC! �� Dosing Chambcr V.Responsibility Statement-I,the undersigned,assume responsibility for installa6on of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP/M�'��umber Business Phone Number t' � � Plumber's Address(Strcct,Ciry_State,Zip Code) � � � � VI.C un /Department Use Only �A i ❑Disappmved Permit Fee Date Issued Issuing Agent Signature ' �� ❑Owner Given Reason for Denial $ /�'� �'a�'°2� � Conditions of Approval/Reasons for Disapproval �--� ,_.,r-��, �....,..��I.--�/"� .�. ni l k` i '�� , ( �L' , � � IU�1,� ��.� !��_�_»�� .� �� f, ' /G� �J \ .�-- � � Date ��.�K�aa ��, � ----�--- e��� �.,_._ . ,v___._ . , �;�� .-�-,; y8q K ;_,!� AUG 2 3 �022 �--� CSr_J.__ � O _____�._ O S g � Ncw INo r t�t '� 3 la- ����:��.;���� ;::���,�;r�{ l v't�fRATION Attac6 to rnmplete plans for system and submk to the C000ty only on paper not ku than S tR:11 inc6ea in sae SBD-6398(R.03/22) N�RCFJNDS AFTER ISSUE OF P�kMt7 PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Ptan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): Kenneth L Staples Phone: $47 _370 _8616 Owner Address: PO Box 51 Z�p; 54835 Project Address: Lot 15 Bechtel Rd Radisson, WI 54867 Govt. Lot: SE �1/4 of SW 01/4, Section �� , T 38 N-R � E❑or W ❑✓ 7'ownship: Radisson County: Sawyer Project Parcel ID #: 022738173405 Designer Information Designer Name: Kurt Brown Phone: 715 _943 2988 Designer Address: 10487 Old Murry Rd Exeland, WI Z�P; 54835 E-mail: brownk@bevcomm.net _, License Number: 22428� Remarks: Signature: ,�� Date: 8 - 22 - 22 Onginal ignature required on each submitted copy. P Ro5 � er K� nt�v �Tt{ �T�PC.ES � �s �`� � �� `'� Y 3v� rf, �. P.� ��x 5 ! �,�� v �����*' �- � � �=. - � `�' �� ^ ' ��-�. �-. � X� ; A ��, ��5 �, �! 8��3 s� , S�/ , S ! '� �T38�1 ,�'lk► OWNER P!flNs `j'� c�� � EcT P oWu O�' <' F�� ���oN Gt� �PIt�G- rt� ;+T ��.R �� T�:'£ 4'�STtM �,. •-,-v � � �, �,��� t S �'�?L'r ?�.? s: � � � r{• � �� � � � � � � .,o ' j . o+ - ' �' s., � - 4y e�� '„ .- `__�� � .��eH►� L �D �._ 8M � �'--�.- `�,``---� � SCRLE� I ��= UQ� / ; , ,,� � , ; �o .� ; � . 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Septic Tank(s)Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA Skaw Precast Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s): 3-ft Trench (down-sizing credit) soo gal 9a� gal gal Effluent Filter Manufacturer: Lifetime � 1/8 Effluent Filter Model#: min.12" SOIL COVER (typlcap 12" min.Vench depth caa���� • TYPICAL TRENCH � • . �� � �� �'�.a ��. CROSS SECTION VIEW �- 34" .�. , . ccvp��an , �• ''� . . (No Scale) , . ... . �. ' Provide minimum 3 ft System Elevation -93.55 � separation between trenches. (typical) Quick4 Standard-W w/End Cap Observatbn Plpe TYPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (ryplcal) Install per manufacturers PLAN VIEW � Instructlons. �NO .SC8�2� ���`�'d;a�� 'd�'�'�e",�� —,- - - - -��- - - - - - - - �� - - - - - - �tiR�x�tr�'�� � o� I ��, ,� � �� �� �A= 3A ft �h���.�I�In�t�,�,���,�� - - - - - - - - - - - - - - h � - -&x'—I. �.a,p� (�YPical) � — �� �'/`_' — — � � G� g = 46 ft m (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typical) � (mfd by Inflltrator Systems,Inc.) � Install pursuant to manufacturers instructions. 11 Quick4 Std-W @ 20 fi� EISA/chamber= 220 ft2 � + 2 Pairs of end caps @ 6 ftZ EISA/pair= �2 ft2 = Proposed EISA per trench= 232 ftZ Required Infiltration Area= 429 ftZ Distribution Method: x 2 trenches = Proposed Total EISA = 464 �1 branched manifold � RESET 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 Disaersal Area Oaeratinq Limits: Design Flow= 300 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 adivities,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 electricai 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 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(1l3)the liquid volume of the tank(s)or as required by local ordi�ance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code. o Effluent filterls)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 repoRs 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:BfOWfl�s Excavating Phone: 715 943 2390 �o�ai 9o�e�„me�t�,,;t:Sawyer County Zoning Dept. Pno�e: 715 634 8288 Locai 9overnment unit address: 10610 Main Street Suite 349 Hayward,WI ZiP:54843 Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisa 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. SYstem Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. Soil ProFile Sheet Owner: � �� I �s o.� SoilTeSter: �rtid.�rf/ � ---� c System Elcvatfon:� �oad Rate: C7�� System Range:�j.� � Ry,� 0o I ` � l .... ...... , . .... ...... `l� .:.... ...... - 99.aS ��— .... ...... , ...... ...... ... ...... � 6 � .... ..... . ..... ...... 8 ,. � ....: � ...... ...... .... —9 . � .... .:.... — 9'�'7. S � � ��� ... ....- ...... ..... ..... .,.... R� ... ...... � 9�. 5 `� . ...... � .. _ ... ...... .... ...... . I / ... ...._ � ... ...... � � .... ...... � . ... , q� Y ...... ....:. .... �� .... _ _ � .... .. I .. .., y'S'S�r-- � . ... ,... .. V ... ... ..... ..:... .. .. � ._... ...... 9 .... ...... _ I . ...... Y.� 2 -- ...... .`� ... :.. .: N �P. � ...... ...... � ..... ...... � ...... ..... ...... ...... � �Y ...... ...... � ..... _..... � ... ...... �3 , ..... ...... � ..... ...... , .. ...... qg ...... ...._. -� 3 .3 �— ...... ...... � .. ...... .. N ��. ..... ...._ ...... � -Qa $� ...... � .. ..... .._. . N�a°. G .. .. ... ...... ..... -Y1.91 � . +3' ..... ...... � .... ...... ... .... , ..... ...... ...... ...... ... ...... l �/ ...... ...... ..... -�3 ... .....: ..... ...... � . ...... .. ..,..... � .... ...... ...... ...... -... ...... ' 9'O, 3 ..... ...... �lo ...... ...... .. ...... ..... ...... .... ...... - 8`�. 8 ...... ...... ..... ...... ...... ..... ...... �' ...... ...... :..: ::.:.. .. ..... ...... , ... ...... ...._ ...... ...... :..... � ...... ...... ...... ..... ...... .. ... ...... � � ..... ... �d 1 . Real Estate Sawyer County Property Property Status: Current Listing Today's Date: 8/22/2022 Created On: 2/6/2007 7 :55 :38 AM Description Updated : 3/9/2017 Ownership Updated: 8/17/2021 _ . _ _ _ __ __._. .__ Tax ID: 22568 KENNETH L EXELAND WI P�N. 57-022-2-38-07-17-3 04-000- STAPLES 000050 CAROL D HAYWARD WI Legacy PIN: 022738173405 GUSTAFSON Map ID: . 12.5 Municipality: (022� TOWN OF RADISSON Billina Address: Mailina Address: STR: 517 T38N R07W KENNETH L KENNETH L Description: PRT SESW LOT 15 CSM STAPLES STAPLES 17/208 #5298 PO BOX 51 PO BOX 51 Recorded EXELAND WI 54835 EXELAND WI 54835 Acres: 0.960 Lottery Site Address * indicates Private Road 0 �_ __. __ ,� _ �_ _ _. Claims: N/A First Dollar: No Waterbody: Couderay River Property Updated: 8/9/2017 Zoning: (RR1) Residential/Recreational Assessment One 2022 Assessment Detail ESN: Code Acres Land Imp. G1- 0.960 11,100 0 Tax Districts Updated: 2/6/2007 RESIDENTIAL 1 State of Wisconsin 57 Sawyer County 2'Year 2021 2022 Change 022 Town of Radisson Comparison 576615 Winter School District Land: 11, 100 11, 100 0.0% 001700 Technical College �mproved: 0 0 0.0°/o Total: 11, 100 11, 100 0.0% Recorded Documents Updated: 8/1/2014 . _ _ _ _ _ __ . _ Property History WARRANTY DEED . _ ___ _ . _._ _ .. ____ Date N/A Recorded: 8/13/2021 433974 QUIT CLAIM DEED Date 405704 Recorded: 3/8/2017 WARRANTY DEED Date 331051 Recorded: 6/10/2005 CERTIFIED SURVEY MAP Date 249705 Recorded: 8/23/1995 l��v /n �Y }'�ay �r� � -f'"� ' ��r '� -� t . ��, t . . . . '�, ,; ,,�`�-�r;�,. t "AS � e '�'t�y '�. * C i.� - t . 8 Y P� � Y'���" R �E�� t `� F �'��°� ��� x� 1 .:. . � '._ki.�},i ��, ,������,.�J �x`� � ..>.��ZZ � .9�d �i�.� n � � i 7D � _ yy ... ,y� 4'' ��` r" '��r ;r`+{�t-� aS.swat4 . �.,'"x�p,f`T ,' .'�", T'�' lr . , . 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"'-'''"`�; PRIVATE ONSITE WASTE TREATMENT county �y' °sp ,� SYSTEMS �,���� � %' ( POWTS) Sa,Wyer � �_ -,. �k"' '�'�� `� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � _- ��Q Personal infonnatio�you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village la Town of: State Pian Transaction ID#: �w�� `� �- �\ C��o� {�q�l ;ss�� � Insp M Elev: BM Description: Parcel Tax No: ��U.d� �as�., o� �e.. � . c�-�-738- ��7-3`�o� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic W g6p Benchmark � �op_o� Dosing pjYv1� � �.a;` Aeration Bldg. Sewer 96. 11` Holding St l Ht Inlet �S; J`� TANK SETBACK INFORMATION St/Ht Outlet 9 , � TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic �-�.p' po� N NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. y y, Holding Dist. Pipe PUMP/51PHON INFORMATION Infiltrative r Surface 9 3.S� Manufacturer Demand Final Grade �. � ` q��S� Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W � L c/ � ` #of Cells a Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate � •' INFORMATION P I L Bidg Well Waters � GP g�' Chamber ` ❑ EZFIow Model Number: CELLTO + �5� Iv lod �o ❑ Mound o Other y — —. _ ---------- ----_ _ -- DISTRIBUTION SYSTEM � x Pressure Systems Only ' ' X Hole Size , X Ho� le Observation Pipes �, Header I Manifold Distribution Pipe(s) I Length Dia Length Dia ___Spac ' _ j Spacing ❑Yes ❑ No_I SOIL COVER — �� -- --- -- — - - Depth Over Depth Over Depth of � Seeded/Sodded Mulched Cell Center Cell Etlges Topsoil _ ❑Yes � No ❑Yes ❑ No COMMENTS: (Include code discrepancies,persons present,etc.) ��,51��� 'S��I a� � � �3�r. -- Plan revision required?❑Yes❑ No I II I,�� � - -- , 6��I� � 1 31 03 a7 � , Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A��ITI�NAL COMMENTS ANO SKETCH SANITARY PEFMIT Nl1M8EA�____ ���e�-�9 _ C�t�, IR;t,�/�' �- 'Ky. �o ;^5�-`a�(pl b(�. � �f�� � �°a� � inSQ' � � �` p w L.T . �^� '"'_"�1 (L �t/Pl.�x: Bm�o l? 9 3 � 3 Q9+ ��s`'� �I L ��) ��) N ��.��� 0 �_ I 5�<__- ��'{� 1 .6��,�.1 �.