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HomeMy WebLinkAbout014-942-35-4209-SAN-2022-310 E '` Department of Safety c°""ty � �s ; & Professional Services, �QW �"� Sanrtary Permit Num er(ro be tilled in by � �s Industry Services Division . i.� �`:� ���' � � Sanitary Permit Application State Transaction Number � In accordance with SPS 383.21(2),Wis.Adm Code,submission of this form to Ihe appropriate governmental unit is required prior to obtaining a sanitary permit.Note Application forms for state-owned POWTS are submitted to Project Address(if different than mailing< d the Department of Safety and Professional Services Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s 1�.04(I)(m),Stats. �S�'�y�/ i3�2C 1-F �e�,v'�- i�-� I.Application Information-Please Print All Information Y�,x� W k ,S�j y 3 Property Owmers Name � " " ' " Parcel# �nlNi lZ PiNt=. GA� ��� C-�3 LZL O l�- Q�Z- 3,�-'+ZO�'j Property Owner's Mailing Address Property Location �Q� , �nN�'L� �Z= Govt.Lot Ciry,State Zip Code Phone Number tUL..�� l—��J� ��- SC`j(t�/� ���'/+.�—'/., Section�� II.Type of Building(check all that apply) Lot� T Z N R � �Ior2FamilyDwelline-NumberofBedrooms 3 SubdivisionName Block# ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of �Town of L.i���C 1 III.Type of PO�VTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i a licable. `� ❑ New S stem y ❑ Replacement System � Other Moditication to Existing System(explain) ❑ Additional Pretreatment Unit(explain) R ace ' B' ❑ Holding Z'ank In-Ground �y}�, ❑ At-Grade ❑ Mound ❑ [ndividual Site Des� n � �'F g ❑ Other Type(explain) (comentional)^ ❑ Change of Plumber ist Previous Permit Number and Date Issued C• ❑ Reneual Before ❑ Revision ❑ Transfer to Ne�v Owner / Expiration �'T-'�33 �./� /C�/l IV.Dispersal/T'reatment Area and Tank Information: Design Flow(�pd) Desien Soil Application Rate(apd/s� Dispersal Area Required(s� Dispersal Area Proposed( � System Elevation �f5� . 7 ��F3 !,�'�o �E��.sf=� Q�2.s�' �€�sr�n,c-� Capaciry in Total #of Manufacturer Tank[nformation Gallons Gallons Units L y o � u New Tanks Ecisting"Canks 'L c L = u v` � � c v � a U rn � ✓, c:. C7 a. Szp[ic ocHniding Tank i Z� �ZS,C ( /` ��.. Dosin�Chamber V.Responsibility Statement- I,the undersigned,assume responsibili for installallon of the PO�VTS shown on the attached plans. lumber's Name(Print) Plumber's Signatu MP/h1�RSNumber Business Phone Number {�lc.$1,:. �2{'f'�� .�s�nuss�� � �,s A `�"; � �s�sl 7�s-��i�-33SS'- PI ber's Address(Street,City,Stare,Zip Code) . � �x.°k. C�(� ��D��� w= S'"`��'2/ VI.Countv/Department Use Oniv �Ap ❑Disapproved Permit Fee Date[ssued Issuing Agent Signature $ Op V � , ��1/� ��q �`L� ❑Owner Gi�en Reason for Denial ����'� I�'i S� + �-�'= ' I��•I.CJ`-e-��''VL�^,;: Conditions of ApprovaVReasons for Disappro��al �� �;:�: i� � � . �- � a Cj`-' � �1_'! =?a------�.�.�" _-- , _- �� ' �� -_.___. -►a� _. OCT 2 � c��2 � ,� � 3 ' � 3 ��"]c� --- �S� �� _ �p � ;: �� �._� ��=f t_a_.� . 5�,, A . . _ _.__ . ���1. _ �o��, .�� .. . , _ Attach to complete plans for the system and submit to the Counh•only on paper not less than S�n_s l l inches in size — . � � --f '1 :1 SBD-6398(R.03/22) PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Com(�on'ent Manua/Design References: Version'�p,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 White Pine Cabin Co LLC- 1250Tank Replacement Owner Name(s): White Pine Cabin Co LLC Phone: - - Owner Address: 1904 Donald Dr. Cedar Falls, IA Zip: 50613 Project Address: 15237 Birch Point Rd. Hayward,WI Govt.Lot: NW 1/4 of SE 1/4,Section 35 ,T42 N-R09 E❑or W❑✓ Township: Lenroot County: Sawyer Project Parcel ID#: 014942354209 Designer Information DesignerName: Jason Kuettel Phone: �15 _798 _3355 Designer Address: PO Box 66.Cable,WI Zip; 54821 E-mail: tim@andryras.com License Number: 675751 Remarks: Signature: �/�� Date:�%�zz Original g �ure re uired on each submitled copy. " ..: ADDITIONAL COMMENTS AND SKETCH =�- � ;��� ;� ��LiC�(yt�� �. , SANITARY PERMIT NUMBER: ��~ Z 3 3 � N�� �; - - -... / ---�� � -_ ` _ , - - , ; ` _ , ' r -1—� .-�- - � ` t-- - ----- ; � __-, _ : _ _ - i- i. .__�_��_ � ! � � I , � ! 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APPP.OV�D M.4TIHOLE c ITl=SH�D GP..�,D� �,�/ ��f�, , i��%�R,�'i,vc t.�48E-(.. �+�'+. 4 " f-(T?�, ,e�� 4-iI r�. I TILET � \ ��OUTLET � ��.-_.�-�--�'— � APPR !_sD BA-���:.�— � O EILTE� AP?r0'/C� h1EG. C7l�t1C(;� PIPE 3 ' QP{TO SOLIO modrl n .�j�,}��z-. 50 IL � " �.:��:�'�1�� E��r��rr� un�F.� ��:t� s�r�zFrcti�r�rrs ���T�c 'j'�J�,�t �i;�lU C,'.C�..�Y�.. . �li ts�/1.- �,'+NC:'ZL.T� T.�;TIjC S � L�..: S�?TIC �Z,S� G,�.i . C..t� IVQTES : 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 3S2-3S4,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 Disqersal Area Oqeratinq Limits: Design Flow= 450 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 activities,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 electrical 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(sl 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(1/3)the liquid volume of the tank(s)or as required by local 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 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: AIICII)/RBSIIIUSS@Il Hc SOIIS, IfIC phone: 715-798-3355 Local government unit: SBWyeY COUllty Z011lllg Phone: 715-634-8288 Local government unit address: 1061 O Malll St. #49 HeyW81"d, WI Z�p 54843 Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 353.51(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 approved by the department in accordance with SPS 384,Wisc.Admin.Code. Continqency 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. Svstem Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. _•$r _�•��4�. ' ~'�'/ (1 _ yw+ .� r� . Y ' �. �' � i r � we - ' j • �_ f : � y .a t� �� Y f � 4 f I� �1: •. i ' p�.. .. � , . 1�� �.f�� . CI �X� , d' ���. �7 I � e ..�i� „y J� . .. P ��" v�t+~r Y � . 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'� � ,�-:~ .,. -^�`�?� 10124122.12:05 PM Real Property Listing Page Real EStdt2 Sawyer County Property Listing Property5tatus: Current Today's Date:10/29/2022 Created On:2/6/2007 7:55:31 AM �Description Updated:2/16/2018 �Ownership Updated:10/17/2022 Tax ID: 18799 � WHITE PINE CABIN CO LLC CEDAR FALLS IA PIN: 57-014-2-42-09-35-4 02-000-000090 Legacy PIN: 014942354209 Billing Address: Mailing Address: Map ID: .14.9 WNITE PINE CABIN CO LLC WHITE PINE CABIN CO LLC Municipality: (014)TOWN OF LENROOT 1904 DONALD DR 1904 DONALD DR STR: 535 T42N R09W CEDAR FALLS IA 50613 CEDAR FALLS IA 50613 Description: PRT NWSE 'o Recorded Acres: OJ00 r Site Address *indicates Private Road Calculated Acres: 0.670 15237W BIRCH POINT RD HAYWARD 54843 Lottery Claims: 1 First Dollar. Yes �Property Assessment Updated:9/26/2014 Waterbody: Nelson Lake 2022 Assessment Detail Zoning: (RRl)Residential/Recreational One �ode Acres Land Imp. ESN: 400 G1-RESIDENTIAL 0.700 136,800 72,800 ��Tax Districts Updated:2/6/2007 Z-year Comparison 2021 2022 Change 1 State of Wisconsin Land: 136,800 136,800 0.0% 57 Sawyer Counry Improved: 72,800 72,800 0.0% 014 Town of Lenroot Total: 209,600 209,600 0.0% 572478 Hayward Community School Distrid 001700 Technical College � C'�U Proper[y History • Recorded Documentr Updated:10/ll/2022 N�q �� WARRANTY DEED Date Recorded:10/10/2022 441747 SPECIAL WARRANTY DEED Date Recorded:2/15/2016 411138 SHERIFFS DEED Date Recorded:10/18/2017 409278 QUIT CLAIM DEED Date Recorded:3/31/2005 329407 QUIT CLAIM DEED Date Recorded:3/19/2004 320108 QUIT CLAIM DEED Date Recorded:4/15J2003 310206 WARRANTY DEED Date Recorded:3/15/1994 240789 https://tassawyercountygov.orglsystemlframes.asp?uname=Eric+Wellauer 1�� '`"�''�'-"'E` PRIVATE ONSITE WAS�E TREATMENT county �y=- F� , �;���SP . \��'; SYSTEMS Sa,W er ``��.�� $ �' ( POWTS) Y \A\rs'.Slit-��5% INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �-02 — ,3 I 0 Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. I 5.04(1)(m)] Permit Holder's Name: ❑City ❑ Village l�Town of: State Plan Transaction ID#: (n���� ���,..Co. L C C ��o� � Insp BM Elev: BM Description: Parcel Tax No: 1 (oo.� o �� ��.,.r' \� ,,, s.`I, 7 "� o��-l- 5'Ya - 3S- `��-O9 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,��� �2�j Benchmark ��,o' Dosing Aeration Bidg. Sewer ^ Holding St/Ht Inlet q�,g � TANK SETBACK INFORMATION St/Ht Outlet �- TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet AIR INTAKE Septic -�-5 �,�` ` �'?� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P/L Bltlg Well Waters � IGP ❑ Chamber Model Number: ❑ AG ❑ EZFIow CELL TO ❑ Mound o Other ---- __ ___ __— - ---- -- _- - -- — _ _ — - DISTRIBUTION SYSTEM__ X Pressure Systems Only - -- — Header/Manifoltl Distribution Pipe(s) TX Hole Size X Hole Observation Pipe� Length Dia � Length Dia Spac Spacing ❑Yes ❑ No � SOIL COVER - — -- -- -- - _ Depth Over Depth Over I Depth of Seeded/Sodded Mulched Cell Center Cell Edges ; Topsoil __ _ __� ❑Yes ❑ No � ❑Yes ❑ No 1 COMMENTS: (Include code tliscrepancies, persons present,etc.) ��..��1� ����� 1�3 � -�'► . ,�,�, . o�� � --- — - ___ � Plan revision required?❑Yes ❑ No �p� �6 a Y � � I/ � -�__�- __ _� I E�� � Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITI�NAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBER: .2�-- 3�'0 S"'""' \D�G� � 11� . . ��. _:.. ... . : . . 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