HomeMy WebLinkAbout010-941-22-1111-SAN-2022-220 . n�-�� - �
,;:`''"°'•"i%; lndustry Services Division County �
��", � 4S23 Madison Yards Way SC�..W ,� � �
I=' �, t p " Madison,WT 53705 Sanitary Permit Number([o be riled in by(
� = P.O.Box 7302 0�
Madison,WI 53707 � 3 � a�� ���
'S �V\ �
Sanitiary Permit Application �`a`eT``'°`��"°°""°,he` qJ
ln accordance with SPS 3R3,21(2),Wis.Adm.Code,submission of this tonn tu the appropriate go��ernmen[al unit �
is rcquircd pnor to obtaining a sanitary permit Note:Application fonns for state-owncd POWTS are submittcd to Project Address(if different than mailing a
the Deparu»ent of Safety and Professional Sci��ices.Personal in�onnation you provide may be used tor secondaiy
puiposes in accordancc�vith the Privacy I,a�ti�,s. 15.04�I)(m),Stats.
i.Application Information—Please Print All information —C�_
Property Owncr's Namc Parccl#
G �' e � �,c�k c� 0 l D —�4 l_ ZZ _ l 1 l t
Property O�•ner's Maii ng Address Property Loca[ion
�o�b� rJ S wt�-F�-. c-� �_
City,Statc 7,ip Code Phone Number
�. c.c�a.� W l S`�Q��3 7!S—�,3�,— 8`t lS
�C '/., �� '/<, Section �"Z'
II.Type of Building(check all that apply) t��# T 4 N R �
_ �' E or V
�I or 2 Family Dwelling-Number ofBedrnoms � � Sttbdivision Name
Block#�
�PPublic/Commercial-DescribeUse
�City of
�State Owned-Describc Use CS'�t Number �Village of
18 (3a �sy y 3 �T���,�,r� ��,�.aQ r
1II.Type oTPOWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Compiete line C if
a licable.)
`�' �New S stem �e lacement S titem )ther Modification to Ex sting S stcm(ex I in �Additional Pretreatment Unit�ex lain
Y p Y' � Y• p ) p )
t�e�.J Se �c. -�'c���
B' �Holding Tunk �n-Ground at-Grade �Mound �Individual Site Design Other Type(explain)
conventional)
C• �Rene�i'al Before �Revisiun �Change ot Plumber �I'ransfer to New OwnerList Previous Pern�it Number and Date Isstied
F.xpiration �6 �Z,� g -. Z.Q ���
IV.UispersaUTreatment Area and Tank Information:
Design Flo���(gpd) Dcsign Soil Application Ratel�,p�Usf) Dispersal Arca Required�;1) Disperx I Area Propused Isf) System F:Icvation
�ESo ,"1 6�{3 E�S � �y� �x q�.�,y `
Capacity in Total tt of Ma��ulacturcr
Tank Information Gallons Gallons Units � ` o � u
Ncw Tanks Fxisting Tank.a �:° '' U � °1 `�
` � v � � � a �a
a U ri� � ✓: i�. Ci Ci
cpC or Hulding Tank (oOO /O ^� O � ���r
b
Dosing Chamhcr � � �
V.Responsibility Statement-I,the undersigned,assmne responsibility for installaHon of the POWTS shown on the attached plans.
Plumber's Name fVrint) Plumbcr's Si�}tr,�tur MP/MPRS Number I3usiness Phone Nttmber
��c�-.�ia� �i�oc'.z,u � � � _,/"� fC"�' l/ � �l �� S S�'— Il��
Plumber's Address(Street,City,State,"Lip Code) �
/ 3 5 G� hf F z-�.-" e � �Q� lf� w�r�, �.l -�Y b"l
VI.Coun /Department Use Only
�App � ❑Disapproved �'ermit Fee l�a[e Tssued I.esuing Agen[Signature
�YV ❑Owncr Givcn Rcason tiir Dcnial 5 I OO•� o I°1'1 I�a �Gt,GI�X�Q'e-��
Conditions of`ApprovaVReasons fnr Disapproval D � ��
� �;
{.- : 8�f a�1�.� �
`�i' 6 2Q2
I� k� c� AUG 2 Z
� 3 &
C S I �� - �.3� ,Nc.�„� w��t� � 3lv� sAw�rER courv��ti��
u���N�-7 A.�.����.5��)1�".)�
A[tach to complete plans for the systc and submit tu the Count}�only on paper not less than R I/2 x nc es in size
SBD-6398(R.02/22)
NO REFUNDS AFTER
ISSUE OF P�kMIT
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version'�. , 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): �e•-�'on. G�,Qr�e►1,� C�Qk.� Phone: 1 LS -6�_- S�► l
Owner Address: 1086R N s�.-�� Ck f}��c,vQr�,� w� Zip: 5'-f 843
Project Address: s�.wt -�
Govt. Lot: �[1/4 of (�J 6 1/4, Section ZZ- , T �-I I N-R o �( E 0 or W �
Township: ��ti t,�c�r� County: ✓���.c�ti c ti
Project Parcel ID #: O [ 0 — 94l — ZZ. — � l l �
Designer Information
Designer Name: ��'�'��/� ��•� � Phone: ��� -r�- ll 3�
Designer Address: �3S`n 1 �/-�:-�ti � / �t Z�p; 54 S 4 3
E-maiL•
License Number: 1 sd //�
Remarks:
Si nature: ' �l� Date: ��9 �a�-�
g Original signature required on each submitted copy.
ti� • �
, f .�.o �sP��a� + 300� ADDITIONAL COMMENTS AND SKETCH �-/y
�
SANITARY PERMIT N BER: �i ro _ zl lv
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PAGE �OF �I
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 Operetinq Limits:
Design Flow = �-Sv 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 mechanlcal 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., distnbution !drop boxes)
c neglect or improper use(i.e., exceeding design capacities, prohibited activit es, etc.)
c extent of ponding in distnbution 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, efc.)
o distribution lateral or lateral onfice 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) shall be pumped by a ceRified 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 reGuired by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent fiiter(s) shall be inspected every 3 years and shall be deaned 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: 4ti 5 ��P��C Phone: ��S ' 3S S _ (/3�
Local government unit .S W e�r- C Zp��,,.0 Phone: —l�S — 63`F—P�2-0g
Local govemment unitaddress: (0� Ib Ma�n � *4-�t �a�uJm�� wlziP: 54ES43
Any defective part of this system shall be repaired, replzced. or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of!alled or malfunctioning components shall comply with SPS 383.Wisc. Admin. Code.
No product for chemical or physical restoration of the PGWTS 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 plar submitted to the appropriate agency for review and approval. A failed in-ground dispersai 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 ir. accordance with SPS 383.33,Wisc. Admin. Code.
8/29/22, 8:21 AM Real Property Listing Page
Real Estate Sawyer County Property Listing Property Status: Current
Today's Date: 8/29/2022 Created On: 2/6/2007 7:55:21 AM
T Description Updated: 6/10/2019 -�°' Ownership Updated: 3/26/2018
Tax ID: 12439 MERTON W & CHARLENE R MAKI HAYWARD WI
PIN: 57-010-2-41-09-22-1 01-000-000110
Legacy PIN: 010941221111 Billing Address: Mailing Address:
Map ID; .1.11 MERTON W & CHARLENE R MERTON W & CHARLENE R
Municipality: (O10) TOWN OF HAYWARD MAKI MAKI
STR: S22 T41N R09W 10869N SMITH CT 10869N SMITH CT
HAYWARD WI 54843 HAYWARD WI 54843
Description: PRT NENE, LOT 5 CSM 18/130 #5443 &
OUTLOT 2 CSM 23/125 #6357
�i
Recorded Acres: 3.825 "' Site Address * indicates Private Road
Calculated Acres: 3.851 10869N SMITH CT HAYWARD 54843
Lottery Claims: 1
First Dollar: Yes � -s Property Assessment Updated: li/9/2015
Zoning: (R-1) Residential One
2022 Assessment Detail
ESN: 444
Code Acres Land Imp.
G1-RESIDENTIAL 3.825 29,700 117,600
m Tax Districts Updated: 2/6/2007
1 State of Wisconsin 2-Year Comparison 2021 2022 Change
57 Sawyer County Land: 29,700 29,700 0.0%
O10 Town of Hayward Improved: 117,600 117,600 0.0%
572478 Hayward Community School District Total: 147,300 147,300 0.0%
001700 Technical College
� Recorded Documents Updated: 4/1/2021 (',� Property History
QUIT CLAIM DEED N/A
Date Recorded: 3/23/2018 411579
WARRANTY DEED
Date Recorded: 2/4/2002 297811
WARRANTY DEED
Date Recorded: 8/8/1996 Z55930
CERTIFIED SURVEY MAP
Date Recorded: 7/9/1996 255297
https://tas.sawyercountygov.org//system/frames.asp?uname=Eric+Wellauer 1/1
��` "T"E` PRIVATE ONSITE WASTE TREATMENT counry
/ ' '
'�� � � �' SYSTEMS
��� ° °S�P � � Sawyer
'��-�� s ��' ( POWTS)
��� `,,,�;
'��---
`'s""��" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� _ ���
Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(I)(m)]
Permit Holder's Name: ❑City ❑ Village �J Town of: State Plan Transaction ID#:
�2r� �-C.�ciC 1�-�- � " a wa� �
Insp BM Elev: BM Description: Parcel Tax No:
10�.�� � o'� cr�C, slq�o �ac� a� �� sZ O p — `2�f — 22, - � � � �
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic (�ie�-�t- - I o0o Benchmark �op,o�
� --�ow.bo boc�
Aeration Bld . Sewer
9 q S,QY
Holding St I Ht Inlet q�6 �
TANK SETBACK INFORMATION St/Ht Outlet � , �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic +� +� ` �Y' ,F��r� NA Dt Bottom
Dosing „ N �� u NA installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative q3 $7 �
Surface
Manufacturer — Demand Final Grade y5-, '
Model Number -- GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W `� � -1�.� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters °� GP Q( Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
-----_ --- _ ----- -_--- —-__ _—-
DISTRIBUTION SYSTEM X Pressure Systems Only
9 ' g pO p X Hole Size X Hole Observation Pipes i
Len�hr/Manifold Dia L�ennbution Pi e s Dia S ac _ _ __ _ , Spacing ❑Yes ❑ No�
SOIL COVER
_ _ _--
Depth Over Depth Over �, Depth of Seeded I Sodded Mulched
Cell Center Cell Edges I Topsoil __ � ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��5���� �I���a
� S7- ,-e.�i�,�- or�Y
��'�
Plan revision required7�Yes❑ No d3 ;p? I .�� � ��� �I G�( �"l�p
-�a�--s�a��--,____----J
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITI�NAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBEA:_ .���-��___
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