HomeMy WebLinkAbout002-940-26-5206-SAN-2022-306 _"`"""`�`� Industry Services Division Counry (n
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---�' �`-� .S a,�1 -PJ(�
' e-,�., 4822 Madison Yards Way �
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;; ..\$p " ,�, Madison,WI 53705 Sanitary Permit Number(to be filled in by(
S P.O.Box 7302
`�`���..`--- "�� Madison,WI 5302 � � � ��'(p �
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Sanitary Permit Application State Transaction Number ,
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit '— d
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a� �
the Departrnent of Safety and Professional Services.Personat information you provide may be used for secondary 8054N Highline Road Hayward 54843
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stau.
I.Application Information-Please Print All Information
Property Owner's Name p���#
Steven&Kathryn Robers 3�te OOa �9��-a6-S�fl(c,
Property Owner's Mailing Address Properry Location
11830 47�`ST NE ���-
Gbvt.C,ot 2
Ciry,State Zip Code Phone Number
Saint Michaei MN 55376 �/,, Y,, Section 26
II.Type of Building(check atl that apply) Lot# T 4 N R 9 E or W
�(1 or 2 Family Dwelling-Number ofBedrooms 3 4 Subdivision Name
. �
Block#
❑Public/Commercial-Describe Use
^' ❑Cityof
❑State Owned-Describe Use CSM Number ❑Village of
5�33� 'TT"��7 Y �Town of Bass Lake
III.Type of POWTS Permit:(Check either"New"or"Replaeement"and other applicable on line A. Check oue bog on line B.Complete line C i
a ticable.
`�� �New System ❑Replacement System ❑Other Modification to Existing System(explain) ❑Additional Pretreatment Unit(explain)
B' ❑Holding Tank (�in-Gmund ❑At-Grade gn ype( p )
❑Mound ❑Individual Site Desi ❑Other T ex lain
(conventianal)
C� ❑ Renewal Before ❑Revision ❑ Change of Plumber ❑Transfer to New Owner ist Previous Permit Number and Date Issued
Expiration
N.Dispersal/Trestmeat Area and Tank Information:
Design Ftow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(s� Dispersai Area Proposed(s� System Elevation o r
450 .7 642 652 .�. 92-92.25 5�,����,
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o � o
New Tanks F�cisting Tanks � c cUi `� � Q � �
a` U in � v� u. C7 ci.
Septic or xo]ding Tank 1000 100Q 1 Wieser x
Dosing Chamber
V.Responsibility Statement-I,t6e uadersigned,assume responsibitity for installation of the POW'I'5 shown on the attac6ed plans.
Plumber's Name(Print) Plumbers Signature MP/MPRS Number Business Phone Number
Kelly Freguson ' � 224069 715-416-4547
Plurnber's Address{Street,City,State,Zip Code)
W9580 Dock Lake Road Spooner WI 548d1
VI.C n /Department Use Only
� ° Permit Fee Date Issued Issuing Agent Signature
App ❑Disapproved � ���Q��
�1 Owner Given Reason for Denial a `�'� +� I ��I'1"� ��'��"''"`"'J��
Conditions of ApprovaUReasons for Disapproval � � } � , ,;t��
,
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Attach to complete plans for the system and submit to t6e County only on psper not less than 8�n x ll inc6es in s'ue
NQ REFJNDS AFTER
SBD-6398(R.02/ZZ) ISSU�OF PE�CMBT
PRIVATE SEWAGE SYSTEM PLAN INDEX PAGE
Owner's Name: Steven&Kathryn Robers
Owner's Address: 11830 47w ST NE
Saint Michael MN 55376
Site Address: 8054N Highiine Road Haywazd WI
Pazcel ID: 3710
Legal Description: S 26 T 40 N R 9 W
Subdivision Name: Lot No. 4 Block
Town of: Bass Lake
County of: Sawyer
Page 1 Plot Plan and System Sizing
Page 2 Plan View and Cross Section
Page 3 SBD-8330
Page 4 SBD-8330 Continued
Page 5 SBD-8330 Continued
Page 6 Septic System Maintenance Agreement
Plumber Name: Kelly Ferguson #224069
Plumber Address: W9502 Dock Lake Road
Spooner WI 54801
Telephone: (715)416-4597
Signature:
Date: 10/6/2022
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Seplic Tank )Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA ,i'o�� �-� �s��-�
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTar�c(s}Volume(s):
3-ft Trench (down-sizing credit) �� ga, ga� 98� _____��
/� /'EfflueM Fiiter Manufacturer.
9 4'�/.��
( Effiuent Fllter Model�l: ��
min,12'
�aa��>
SOIL COVER
12"
min,Vench
�ry���> •: •�' TYPICAL TRENCH
� • ,• � . •'" �•• CROSS SECTION VIEW
. .a ,
�"--iaP,�' .;.,• .a .. . . , (No Scale)
n �I a.• ' e♦
, Provide minimum 3 ft
System Elevation=� ft separation between trenches.
(rypfcal)
Quick4 Standard-W
w/End Cap Observatbn Plpe -�-Yp�CAL TRENCH
(typical) (Show location of inlet/outlet pfpe connection on plan view.) (�yp���)
Install per manu(acturer's pLAN VIEW
'"5'"'°"°"s. (No Scale)
r�V $Y`� pJ�H�':��A`H�a`��C��r::,— — — — ��- — — — — — — — �/f- — — — ,,�Q,�H'�'��Is���1'd�t�K 4a�`"���I A= 3,0(t
I � ,+� � �ilo�� fil, j;l��llt� ���;� .1 ` il;l l I�i.)i�l� � i�d,ilh tipl'�!.�) � �
�y�AuFS:�.N!iIwP4�4�5k.�,�kl�kii4d — — — — — — — — — — — — — •KR,.'eldu�w�'�4f_1+��i(4�1£.R'hr')w� <<YP�) �
�—..— — — — — — -�j�- �j� G�
B = ,G��f� ft —=i fTl
(rypical) Quick4 Standard-W Chamber W
(�Yp���? Q
INSTALL PER TRENCH: (mfd by InflltratwSystems,i��.� -n
Install pursuant lo manufacturers InsWctions. �
�Quick4 Std-W @ 20 ftZ EISA/chamber= � ftZ ,
+ �._ Pairs of end caps Q 6 ft�EISA/pair= � f�z
= Proposed EISA per trench= _:.1,a� ft2 Required Infiltration Area= � ` ft' Dist�ibution Method:
x ,� trenches = Proposed Total EISA= �� ft2 �/� } o��
CRE$ET '
PAGE40F4
In-ground Gravity Management Plan
IMPORTAWT:
The owner of this in-ground gravity system shall be responsible for fts 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 inspec[ion and maintenance activifies shall be perfortned by a registered POWTS MalnWiner in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Disnersal Area Ooeratina Limits:
Design Flow= i�� gpd; BODS<_220 mgL''; TSS<_150 mgL''; FOG 5 30 mgL''
Insaection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e.odors,user complaints,eic.)
o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.)
o material fa6gue(i.e.,leaks,breaks,corrosion,etc.)
o solids volume in anaerobic treatment tank(s)and any disfibution appurtenance(s)(i.e.,distribution/drop boxes)
o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,efc.)
o extent of ponding in tlistribution cell prior to dosing
o dasing irregularities-'rf applicable(i.e.,pump re-cycling,float switch settings,etc.)
o electripl components-if applicable(i.e.,wiring,connections,switches,controis,timers,alarms,efc.)
o distribution lateral or lateral orifice plugging (measure Iaterel distal pressure—compare to design specifica8on)
o surface discharge of effluent or sewage back-up into structure served
M�intenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Seotic and dose tank(sl shail he pumped by a certified septage servicing operator licensed under s.281.48 Wis.
Stats.when the volu�e, of solids in the tank(s)exceeds one-thircl{1/3)the Iiquid volume of the tank(s)or
as required by local o�7}i`iance. Disposal of corrtents shall be pursuant to NR 113,Wisc.Admin.Code.
o Effluent filter(s►shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacture�s specifications. A servicing pe�iod 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. Raport any component failure or malfunction to:
Name of individual or company:v.,_�-r��yE' �l��a n �-ca � , Phone:�S�!'y�f-/J�q
Local govemment unit_5 , r �o�-�,�-. 1� ,,,� � Phone:J/S'—l3-//—,fj,2,�8"
.
Localgovemmentunitaddress:,l�C'!'J °�'1,.;, ',f �L�g �,��y��rJ Z�p;]/'.,��frl �'
My defeCtive part of this system shail 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 approv�by the department in
accordance with SPS 384,Wisc.Admin.Code.
Cotttinaencv Plan
In the event that any failed treatment component of this POWTS cannot be repairad,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 383.33,1Msc.Admin.Code.
r`` �'� �. 16� 6 fi 6 �
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d PaO� t1'� n . e
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Repktar
aP�W
SANYEFt COUNPY CFRTIFIBD SURVEY MAP A10. _
�
� Set 3✓4��X 24`� IP. •vt. 1.13 lhs/tw E. Town Roo d — �
2QZ.10 � y
g73"A?�`N ��
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FD. S9C NW ; o
Cor. Sec. 26 �'`'ac - � c`"n.
� ' ��;,� 1 .25 Act � m 2.34 Ac F �
N � ,� �� o,��o. $
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rn ~ 2 � �'�� � • N O w
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246.47� ' N87°21�40��E 59&84�
SUKVEYOA�S CERTI_ FICA�
I�I.7II8 1,. F3.1.IOTT, rogistered land surveyor� hereby certify that by tho direction of
l�iS. J. JO�FS� I have aurveyed and mapped the land parcel xhich is repreaented by this
Certified ;,urvey Map:
That the e�:terior boundary of tho land parcel aurveyed and mapped ie deacribed as Sollowas
• A part of (imrernmr,nt Lot 2� Section 26t Tormship 40 Northf Range q lJest� Town of Bass
Lake, Coun�.y of 5awyer� State of FJisconain and more particularly described as follows:
Camnencir�g at the Northxest Corner of Section 26; thence S 2� 32+ E along the Flest line
of said Se�:tion zb 12q8.20 feet. Thenca N 87° 21� !,0" E 2l�6.1,7 feet to an iran pipe
being the poirit of Beginning;
thenc�� continued N 87° 21+ 40" E 59�•84 feet to an iron pipei
thenG� N 2° 39' W b53•�g feet to an iron pipe�
theac�: S 73° 4?' '.�247•10 feet to an iron pipe;
thenc�� S 61° 31' W 233•G2 reet to un iron pipe;
thenc�'S 32� 37` W 170.93 feet to an iron pipei
thencs S 15° 17� W 162.76 feet to the gnint of Seg�nning, said parcel contains
4•59 acres mora or leas and sub�ect to ar�y easement of record.
That [ have fu]1y complied �th the provisions
oP Chapter 23�3k of the ffiacansin revised
Statutes, af ��1,�„and mapping same.
F••��� r�'+,,''�'
��'� L. ' , 5urveyor
s �,a; � Wisconsin Regiatration S-1300
. -- t� sisoo .�� Dates Muy 12, 19')'8
� � • _
: �rooNw. �
� /4/
, ��r-.���,�..,.,,.,..�4,,•'' �-��.�,��,�1� =�1? � .�
ClTtlliAd SuTVEq NO.�L���,�.,�j���Qrs`utl�iV��`,,, �T q-GG��L � /�""'�' Cr..1'r.. . 3 .' �
PAULA CHI95EH
SAWYER COUNTY, WI �
SI'A7EBA0.0FWISCONSMFORMI-1000 0.EGISTEP OF UEEDS
�H�, WARRANTYDEED
315222
T6{e Detd�made betwan JUAMTA JONES,ao udult woman, 09/l2/2UO3 9:50 AN
Grentor and KELLY J.SUNDERI.AND aod SONYA M.HARAINGiON,
�Mglaadnllt,mJointteuentl,G�en[ee. RZCOADING FEE 11.00
Grentor,for e vaheable coasideretion,wnveys to Granue U�e folbwing T�5 eEa eEE 30.e o
deunbed rcel estete In Sarrycr Cawry,s�e er wi�u��One••ero�eny^): pages 1
�t�
Neme�00 PeMn AdLea
11�)RI10�/IIOIr�.
. ����1�
�'���" �
�w����n��9
�3i7o•�-
OOb94b26 52Q6
PvoN IdeoHllcWan Numbtt(PQJ)
Thlf b not homa�md pmperty.
(is)Ih no�)
7'6at part af Govsromrot Lot Two(2�,Sectbn 7Wroty-fli(T6�Townahip Forty(40)Nor16,Ron;e Nlne(9)Wnr,morc
penteularly daert6ed as Int Foar(4)e�rerordcd io Votume Ffve(�ofCerNfied Survey Mapf oe pege 336,Sorvry Na 1070.
Leg�l dexriplloo provlded Ey Floyaard Land Tille Comp�oy.
Togelha wiN all appuneoent righn,Htle and interab.
arenWr warrenn tLet the Utla ro Ne Aoperty I�good,Indaha5ible M fa sMpla end Ren ond clear of encumb�en«a acept,
all ee�emeob,e:ceptlom and rnervetlone of rceord.
Deledthisy�doyof ceoT�_20D3•
�.�wwl.OY�Al�
•N A JONFS
AUTli6Pi'I7CATION ACKNOWLBOGMENT
Signemrt(s) STATEOF rcrnxcru )
�9!.
CAM'F.Ii COYIIh' �
91Hht11l�WlCd�1{3_d8Y O( �_
Personally ceme befwe ma this LOth day of
SBPTEMBER 200; Ihe060Yellamed
JUANITAJONBS
TITLB:MEMBEA STATE HAR OF WISCONS C
(Ifnoy � � tobe�hepawrts)whoacauudtl�efmcgomg
authorind 6y 4T06.06.Wis.Stab.) � rnt and admowledged Ne same.
T}US QJ57RUA4iP1T WAS DRA � �—'
Alroro 7LomuJ.DoR E)
Ha N WI Public,Stateof \ WISCONSIN .
M ission fyprnnmimt pf not.s�e up'vadon darc:
(Si6n�+�rla.uUsiuimNworYrowteedca uou�uem�ncmwyl L O .)
o v�m�pbnBlnmY m�m wo� �nc a8�+� rtlw�vaa IroopfYwll ...�opmfaw�m
SIATE BAR01 WKCdYSVi
WAPWMY 088U FORM Na I-]000
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SEC. 26 TWP 40 N.
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10/18/22,8�.17 AM Real Properly Listing Page
Real Estate Sawyer County Property Listing Property5tatus: Current
Today's Date: 10/18/2022 Created On: 2/6/2007 7:55:08 AM
'�Description Updated: 5/2/2011 '� Ownership Updated: 5/2/2011
_____.. . .--- .__. __--- �
Tax ID: 3710 � � � STEVEN R&KATHRYN M ROBERS SAINT MICHAEL
PIN: 57-002-240-09-26-5 OS-002-000060 MN
Legacy PIN: 002940265206
Map ID: :2.6 Billing Address: Mailing Address:
Municipality: (002)TOWN OF BASS LAKE STEVEN R&KATHRYN M STEVEN R&KATHRYN M
STR: 526 T40N R09W ROBERS ROBERS
11830 47TH ST NE 11830 47TH ST NE
Description: PRT GOVT LOT 2 LOT 4 CSM 5/336 SAINT MICHAEL MN 55376 SAINT MICHAEL MN 55376
#1074
Recorded Acres: 2340
Calculated Acres: 2341 � Site Address " indicates Private Road
__—_ -----. ___ _._._ .
__—
Lottery Claims: 0 8054N HIGHLINE RD HAYWARD 54843
First Dollar; No
Zoning: (RRl) Residential/Recreational One J property Assessment Updated: 9/13/2012
ESN: 406 .. .. __._-----------_._.. ... ....
2022 Assessment Detail
Code Acres Land Imp.
`� Tax Districts Updated: 2/6/2007 Gl-RESIDENTIAL 2340 16,700 0
______... .. ____ --_ ._
1 � � State of Wisconsin
57 Sawyer County Z-Year Comparison 2021 2022 Change
002 Town of Bass Lake Land: 16,700 16,700 0.0°/a
572478 Hayward Community School Distric[ Improved: 0 0 0.0%
001700 Technical College Total: 16,700 16,700 0.0%
•� Recorded Documents Updated: 2/5/2014
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WARRANTY DEED Property History
Date Recorded: 11/22/2006 343132 N/A
https://tas.sawyercounrygov.org//systemlframes.asp?uname=Eric+yVellauer 1/1
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