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010-840-03-2203-SAN-2022-328
' Industry Services Division County � � i 4822 Madison Yards Way Sawyer � _ , S' Madison,W I 53705 Sanitary Permit Numbcr(to bc fillcd in by Z $ P.O.Box 7302 �'�.,. _ Madison,WI 53707 � �� � C� � Sanita� Pel�lt Apn71Cat10n State Transaction Number � ri In accorclance with SPS 3A3.21(2),Wis.Adm.Code,submission of this fortn to the appropriate govemmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted[o Project Address(if diffcrcnt than mailing �Q the Department of Safety and Professional Services.Personal inforenatfon you provide may be used for secondary purposes in aecordance wi[h[he Privacy Law,s. 15.04(i)(m),Sta[s. I.Application Information-Please Print All Information 5`r�� Property Owner's Name Parcel# JATHAN L & REBECCA S BRUBAKER D/v ��•o • 10 - Property Owner's Mailing Address Property Location 9616N ROUND LAKE SCHOOL RD �,,��- City,State Zip Cale Phone Number HAYV1/ARD WI 54843 715-699-2072 Nw �%,Nw ��,. Section 3 II.Type of Building(check all that apply) Loc# r40 N R 8 E W �I or 2 Family Dwelling-Number of Bedrooms 6 1 Subdivision Name __ Block# �ublic/Commcrcial-Dcscnbc Usc �— ❑City of _ ❑State Owned-Describe Use CSM Number illage of _ 31/75#7681 �TO`""°f Hayward _ llL Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i a licable. A. ❑New System nReplacement System ✓ ther Modification to Existing System(explain) ❑Additional Pretreatment Unit(explain) LJ ystem Addition B' �I-Iolding Tank aln-Ground �AAt-Gtade �Mound Individual Site Design Other Type(expliin) (conventional) C• ❑Renewal Before �Revision �C'hange of Plumber �T'rartsfer to New Owner ist Previous Permit Number and Date Issued Expiration 0O^ y(?j �O Y �C�OQ IV.DispersaUTreatment Area and Tank Informarion: '' _ ► Desi�Flow(gpd) Design Soil Application Rxte(gpcUs� Dispersal Area Required(s� Dispersal Pro osed(sf) System Elevation � 900 .7 � �,�86 'F�8r5-��,1 = 91 , Capacity in Total #of Manufacturcr �p� ' � c Gallons Gallons Units a� �j � u Tank Information � � .a � y N Ncw'Canks Existing Tanks � o Y � Y A� � a U (n �, �n r.r. C7 0. Septic or Holding Tank X 2�� 1 Wieser � Dosing Chambcr � � V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' ature MP/MYRS Number Business Phone Number Luke Schmitz �-� 884121 715-520-2434 Plumber's Address(Street,City,State,Zip Code) PO Box 160 Shell Lake WI 54871 VL C u /Department Use Only 11 9 Permi[Fee Date Issued Issuing Agent Signature �App o ❑Disapproved � {-��� • ❑Owner Given Reason for Denial $ `O�' �+ I`� ' ���"- �����' ' " "� Conditions of Approval/Reasons for Disapproval ,- � '' � � �, �) '' .-. � i I ��� , ' � s�.�:,,,._. -- -- , ; , _ ___ _.. � ��GI � � 35�� �_��.t�� ���� o � . � � ���� r�k# -, CS I �� "�v.�—j � ��,��►��w ,�r�� .�,��.���f __ � -- ------ �' ���c.,.,�����„� , -{:� . .,.a Attach to complete ns(or t6e system aod submi[to the Couqty only on paper nof less than 8 t/2 x 11 inches in size y��,5 g SBD-6398(R.02/22) NO R�FJNDS AFTER ISSU�OF PERSIA�� PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version �Q(, SBD-10705-P (N.01/01, R. 10/12),,, ��.1.�.�� a.� �. 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: Tank specs POWTS Application for Review Filter specs Soil Evaluation Report & Site Map Project Name / Description 3 Bedroom Septic Addition for total of 6 Bedroom Owner Name(s): �ATHAN L 8� REBECCA S BRUBAKER phone: 715 _699 _2072 Owner Address: 9616N ROUND LAKE SCHOOL RDHAYWARD WI Z�p: 54843 Project Address: Govt. Lot: NW 01/4 of NW 01/4, Section3 , T40 N-R8 E❑or W �✓ Township: HAYWARD county: Sawyer Project Parcel ID#: 010840032203 Designer Information Designer Name: Luke Schmitz Phone: 715 _520 _2434 Designer Address: PO Box 160 Shell Lake WI Z�p: 54871 E-mail: digupnorth@gmaiLcom License Number: 884121 Remarks: C Signature: � Date: 11-3-22 Original signatur equired on each submitte p m A - � N Q7�1N�.� � a 9 — o o� o — z�—� V L fn ' � p f ., � O C� =Z ' v o 0 � � 'm� �^ � �m �i — [n�— O� r s �D -� CO = ^� v, � �p m �` �'° F T - � � � � N �. � � N � � � � N /�� _�� V 3 � � � � 3 v�i a ° " �N = a� n a - Nw r Z �o �� r- f a� c� < a -3 D o� � o� D N � 3 � �o;)�n=a O c°'i+ �^D�F _• m j y '^ ��'D`�Z m � Ng�ay�` o �ZN� �°D �0 0° o A C � — o#m �Z D n � ���N �Z N m � A D� ' 1p�mW A T =�Q C� O y � p� Z �m � c r j O x m -� A (n N$� � � �' o n fD m g3 � cn �0 3 a ii �m Z �' o a m � N o m � IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) � '"'" tz TYPICAL TRENCH SOIL COVER (rypicep __ CROSS SECTION VIEW ,r min.irenrn (No Scale) tleplh INv�cap . .. n . �- 34.. �'� .. . �ryp�`a�) �:;�, � � ' Provide minimum 3 ft e . � ° separation between trenches. System Elevation = 91 ft (typical) Quick4 Standard-W w/End Cap Observatlon Pipe Show location of inlet/ outlet i e connection on lan view. Oya��aq (typical) P P P � TYPICAL TRENCH ��s�anpermanutacmrers pLAN VIEW instmctions. (No Scale) ���e��f��Rn�e����t�1I�11'' __ _ �� _ - - _ - - - �� — _ _ —�a.�e�e�R��w�e��ss• 4l � � - - - - - - - - � � ` ��� �A= 3.Oft I�Y��IY�Yiff���Y���i _ �� _ _ �� _ _ _ ♦�Y11Y1���Yi�YY�YY � (�yPical) V � g 68 ft i � (typical) quick4 Standard-W Chamber �TI INSTALL PER TRENCH: (ty����� �''� (mftl 6y InfiltratorSystema Inc.) O Install pursuantto manufacturefs instructions. �� Quick4 Std-W @ 20 ft� EISA/chamber= 340 �= 77 U'1 + � Pairs of end caps @ 6 ft'EISA/pair= 6 ft' = Proposed EISA per trench= 346 g� Required Infiltretion Area= 642•8 ft� Distrib�tion Method: x 2 trenches = Proposed Total EISA= 692 n� branched manifold � RESET PAGE 4 OF 4 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 Disqersal Area Operatinq Limits: Design Flow= 900 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 matenal 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 dasing 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 dis[al 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: SChI711tZ S2PtIC & EXCaVating LLC phone: 715-520-2434 �ocal government unit: SBWye� COUflly ZOfllflg Phone: 715-634-8288 Local government unit address: H8yW8�CI W) ZiP 54843 Any defective part of this system shall 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 approved by the department in accordance with SPS 384,Wisc.Admin. Code. Continaencv 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. W2000— MR TANK SPECIFICATIONS � a o � a � I � 12'-7" DIMENSIONS: � o WALL: 2 1/2" a a BOTTOM: 4" COVER: 6" ---- ---_ MANHOLE: 24" �.D. PRECAST CONCRETE RISER Q .-:'__==___-- ���' '�:� HEIGHT: 66" � �� .� �� �� LENGT}i: 12'-7" i�� 4" CAST-A-SEAL 4" CAST-A-SEAL ��� ' � � WIDTH: 7 -2 �i --\ ��-,\��` BELOW INLET: 53" N � � � LIQUID LEVEL: 46" � i i � i WEIGHT: 15,370 LBS. � o ` � \ °- o � ����--' T2A•. �` -'��� INLET AND OUTLET: =� 3 0 0 "�� r�O // 4" CAST-A-SEAL BOOT OR EQUAL GASKET � m o a �� • FILTER OR BAFFLE /� o c`� �� ii w `�� _---'// �;' INLET AND OUTLET BAFFLE AND FILTER: Q Q � �;.; ���_____________ ��' WISCONSIN, SEE DETAIL #10 N o o ; -- -------- ---�� (OTHER STATES SEE CHART) W � � LIQUID CAPACITY: 42.92 GAL/IN W n �. � TOP VIEW HOLDING TANK: Y � OUTLET HOLE PLUGGED � � � ACTUAI. CAPACITY: 1,085 GALLONS � � � � LOADING DESIGN: 8'-0" UNSATURATED SOIL � Q � cn � � � N ¢ a TANK CAN BE USED AS: o I +� SEPTIC / HOLDING / PUMP OR SIPHON � � o � = o0 ____ COVER: MIX DESIGN #8 (NO FIBER) 4+ �n ---- _� TANK: MIX DESIGN #10 (STRUCTURAL F�BER) � � -- --- INLET - OUTLET CUSTOMIZED TANKS: � � - U, i � i FOR CUSTOM TANKS CONTACT WIESER CONCRETE �� i i �Q � ^ d ' � c0 - � � _ � _ � '� � � � � � O J I I � � 21�� � � �j Q 2 . �-;--------- -----,—., -----------' O � REVIEWED BY o c� � REVIEW DATE 3 a w SIDE VIEW DRAWINGS SUBMITTED � FOR APPROVAL APPROVED BY: SHEET N0. APPROVAL DATE: � � OF - PRODUCTS NEEDED BY: / � TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS — __ 33.02 83.9 cm — _ 20.71 52.6 cm, _ . _ __ --� 4"(10.16 cm)BALL HOUSING �i TRAVEL I FILTER CARTRIDGE MATERIAL-POLYPROPYLENE I _ A ' — 5.7$ '14.7 cm= —I MATERIAL-FILLED POLYPROPYLENE -- -- —�� ' ' ° _ .. , ... '. 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I i�I l,�uk�Jll � � ��r�� li��IGll.11 ua 1„��I�I��u�I� ����i�I����ti_G 0� � � I�����,�� 1! �� �'�� � � ��.� � ��°°� � 1 ��r��,lil�llll�i� ��![�E��G 1�111�-,�,, �I�°� ��� ��11i11 ��i ���� � I� � �91�1�� ..�II Ci��'��111 i� �� 'z����a � �--� � � fi � .. .._�� �� Q � nrrt�� 9IV�.t. � _ �li _._ �•���_ _ -` :_ ��,I ,�'� �� �, ,���� ;�'��,���� ��'�k����,���, �„�„k,1������4 I�d��t�.�( p����r�� mm�4 t��N�a�� ��� ���������� � I ���� ������� �� � �� - � -fi r`� � II � � 7� i���q Ii � �; — , , ; � � b � .� �� ���� a �k � ��4;d'�.b ti� �k�E��c � ��-, :� - _ � � -r�_ `-li �` I ,i���i'�����I�,�� I'�''i�i ��II�I�I I�����I '' II���I�II�Iilbddtl�Vdtll�(aBI�NV�VtiNd��VN�nauu�u���t���ia���iii��ir' ; , 9 �r_ �' �. �T�_.'��` ,���?s��y�1._ 1 � _ ' _�-_-`_ _ _ �{j— -_.. �,_� = _ - � �`� _ -�--� �� _ � -�-- - _T . - � � '�i� �;-� �- � ,` f � T � , � � BALL PUSH ROD ::�% k� ' ' � � � FACTORY INSTALLED SECTION A-A `�� �:; �' �o _ :r .� _- — ----�--� ,_ A MATERIAL-FILLED POLYPROPYLENE � I 6.5"(16.51cm) SEALED BALL — ' 4"AND 6"FACTORY OPTIONAL BUSHING � MATERIAL-HDPE INTALLED PIPE OUTLET (FOR 4"THIN WALL PIPE) MATERIAL-PVC PART N0.30142-R OR OPTIONAL FLOAT SWITCH POLYLOK PL- 525 - 625 CUTAWAY (FOR 110 MM.PIPE) PART N0.30142-EUR 11/8/22,11:18 AM Real Property Listing Page R2dl EStdt2 Sawyer County Property Listing PropertyStatus: Current Today's Date:11/8/2022 Created On:2/26/2010 9:44:40 AM �Description Updated:3/1/2010 ''�'�Ownership Updated:3/1/2010 Tax ID: 40658 ]ATHAN L&REBECCA 5 BRUBAKER HAYWARD Wi PIN: 57-010-2-40-OB-03-2 02-000-000030 Legacy PIN: 010840032203 Billing Address: Mailing Address: Map ID: .63 ]ATHAN L&REBECCA 5 ]ATHAN L&REBECCA S Municipality: (O10)TOWN OF HAYWARD BRUBAKER BRUBAKER STR: 503 T40N R08W 9616N ROUND LAKE SCHOOL RD 9616N ROUND LAKE SCHOOL RD HAYWARD WI 54843 HAYWARD WI 54843 Description: PRT FRAC NWNW LOT 1 CSM 31/75 #7681 Recorded Acres: 5.010 w Site Address *indicates Private Road Calculated Acres: 5.011 9616N ROUND LAKE SCHOOL RD HAYWARD 54843 Lottery Claims: 1 First Dollar: Yes i..�property Assessment Updated:4/18/2022 Zoning: (A-1)Agricultural One 2022 Assessment Detail ESN: 446 Code Acres Land Imp. G1-RESIDENTIAL 1.000 14,000 82,000 -�Tax Districts Updated:2/26/2010 G4-AGRICULTURAL 4.010 600 0 1 State of Wisconsin 57 Sawyer County 2-Year Compariwn 2021 2022 Change O10 Town of Hayward Land: 14,700 14,600 -OJ% 572478 Hayward Community School District Improved: 82,000 82,000 0.0% 001700 Technical College Total: 96,700 96,600 -01% �• Recorded Documents Updated:3/1/2010 � WARRANTY DEED �'L'R Property History Date Recorded:2/2/2010 365035 parent Properties TaxID 57-030-2-90-OB-03-2 02-000-000010 SO551 Child History Remrd Count 1- HISTORY O Expand All History White=Current Parcels Pink=Retired Parcels O Tax ID:10551 Pin:57-010-2-40-08-03-2 02-000-000010 Leg.Pin:010840032201 Map ID:.6.1 40658 This Parcel Parentr Children - https-//tas.sawyercounrygov.orglsystemlframes.asp?uname=Eric+yyellauer ��� �. � �I1�I� _ �y ._ �"ii. �*n.r'' 111M'` ' � � I I 7-+�',,• Y,s•`�' ryi.;,�. . � r ' � ��y�,• f �` --�' rfg � � "'�k � ��� � r ��`� II � ��+ � � f y- _ _ � j w!` „ �k � l �f�i` ` � � � . � � �Yf' ( ' . , �' � r� j�'.�� � � . 9�'�+�'�', ','.'��y�,.� '� �� �r .. � . 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Sewer Holding St/Ht Inlet y S S�� TANK SETBACK INFORMATION St/Ht outlet ��; 3�' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic +� ��' %(S` t�S� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. �Y,$� Holding [3is�-P+�, 5 3,$i PUMP 1 SIPHON INFORMATION Infiltrative �7� e� � ,o� Surface Manufacturer Demand Final Grade Model Number GPM � ( �b�Yr TDH Lift Friction Loss Sys Heatl TDH Ft �,pg� Forcemain L Dia Dist.To Well � c�, �S-r DISPERSAL CELL INFORMATION DIMENSIONS W L ' � g� #of Cells 3 Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate �I, INFORMATION P/L Bldg Well Waters °� AG �A( Chamber Model Number. ❑ EZFIow CELL TO .f-�o� ( ❑ Mound o Other QY f , . - - -� _�"'s�-- ti __---- - —___-- DISTRIBUTION SYSTEM x Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac Spacing ❑Yes ❑ No � -- — — -- -�- -- --------- SOIL COVER_ _ ______ � Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center Cell Edges Topsoil _ � 0 Yes ❑ No � ❑Yes ❑ N� COMMENTS: (Include code discrepancies,persons present,etc.) ����� / � I� �l.6 �-� � Plan revision required?❑Yes� No �3 (3 �3 � �%_-"� _ � (j J,� r� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS ANO SKETCH SANITAAY PERMIT NUMBER: ��2 —',��g , y� : _ , _ .:__ , _ _,__ tX`{� (lb> , � ._ , _ • . ��) . _ . o �-� . . ._ . ; r ; • , \ i ; . , ._ .__ , ` , ,..._. . _ .t__ _.e , \ .__._ _._ � �� '—' ,a i � �,, __ —� . . 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