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Home My WebLink About008-937-19-5702-SAN-2022-330 v""'"-'"�\ Industry Services Division County � =�� ;� 4822 Madison Yards Way Sawyer Z ��' 85 Madison,WI 53705 Sanitary Permit Number(to be filled in by c ' � P �.<� ! `; $ �,; P.O.Box 7302 . } � � �—�.�r' Madison,WI 53707 � 3�I � U�� "Lx�ro.ni/ State Transaction Number � Sanitary Permit Application "`' ,� (,V In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit d is required prior to obtaining a sanitary permit.Note:App]ication forms for state-owned POWTS are submitted to Project Address(if different than mailing ad�___.,, the Department of Safety and Professional Services.Personal information you provide may be used for secondary 16837W MAPLE TERRACE D R purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. I.Application Information-Please Print All Information Property Owner's Name Parcel# JORDAN L & JOELLE E SEDIVY 008-937-19-5702 Property Owner's Mailing Address Prop�e(rty Location 1797 198TH ST �t Govc.Loc� City,State Zip Code Phone Number CHIPPEWA FALLS, WI 54729 7� qyy_ �a6 �—✓'�Section 19 II.Type of Building(check all that apply) � �/, Lot# T 37 N R 09 E or W �1 or 2 Family Dwelling-�'umber ofBedrooms Subdivision Name Biock# ❑Public/Commercial-Describe Use vJ � �City of _ ❑State Owned-Describe Use CSM Number ❑Villagc of �Town of Edgewater III.Type of POWTS Permit: (Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C if a licable.) A' �New System nReplacement System ❑Other Modification to Existing System(explain) �Additional Pretreatment Unit(explain) LJ B' �Holding Tank �In-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain) (conventional) C• ❑Renewal Before �Revision ❑Change of Plumber �ransfer to Ne�v Owner List Previous Permit Number and Date Issued Expiration IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Requircd(s� Dispersal Area Proposed(s� System Elevation 450 0.7 643 '�� 1`��°� Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units � � o � � New Tanks Existing Tanlcs � o � � Y ,� �a m w U v� � cn w C7 W SepticorHoldingTank 1000 1000 1 WIESERCONCRETE ✓ � Dosin�Cha�nber � � � � V.Responsibility Statement-I,the uudersigned,assume responsibility for installa6on of the POWTS shown on the attached plaos. Plumber's Name(Print) Plumber's Signature MP�PRS Number Business Phone Number Travis Butterfield 652879 715-634-8176 Plumber's Address(Street,City,State,Z.ip Code) 14346W St. Rd. 77, Hayward, I 54843 VI.Co n /Department Use Only I I Permit Fee Date Issued Issuing Agent Signature App v ❑Disapproved _ - $yo� �° �� s�� t�u.,�,,�� -j��- - ❑Owner Given Reason for Denial • Conditions of Approval/Reasons f6r'Disapproval D � n i i � — �=�- ._..._ :� \', � _� , k ; �l �-'' Fr :.r�lc# � I �S - NOV 0 4 2U22 _ � �I I N�L � L .___ .-� . � ,��yi , �l�r �c�l _. . �I'� <;R;�1� " 'a � : � S ) ��— .��J�I � _�f-�� z�;vir�;��.ti�;t�:,: _,. Attach[o comple[e plans for the system and submit[o the County only on paper not less than 8 ll2 x 11 inches in size �� ] � v— sBD-639s�x.o2iz2� NO R�FJNDS AFTER "�"�i{a��v F-� I S S U E O F P E R M f T �hall not be created ��ssorY structures 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 & 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) : JORDAN L & JOELLE E SEDIVY Phone: - - Owner Address: 1797 198TH ST Z�p: 54848 Project Address : 16837W MAPLE TERRACE DR Govt. Lot: 1 /4 of 1 /4, Section � 9 , T37 N-R �g E ❑ or W ❑ Township: EDGEWATER County: Bayfield Project Parcel ID #: 008-937- 19-5702 Designer Information Designer Name: Travis Butterfield Phone: 7 � 5 _ 634 _8176 Designer Address: 14346W St. Rd . 77 , Hayward , WI Zip: 54843 E-mai� : office@butterfielddrilling .com �r�,�5 s��a�e �-�ser��ea r-�, a��r�.��,1 st�,�„p. License Number: 652879 Remarks : Siqnature : _ -- - Date: �� ZZ Original signature required on each submitted copy. CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE. � SOIL EVALUATION Scale: 1"=40' � SYSTEM PAGE 2 OF� SITE MAP � 40 60 80 PLOT PLAN PROJECT NAME: �a2 DESIGN FLOW: �}rJO GPD JORDAN L & JOELLE E SEDIVY Attach design flow calculations for commercial plans. PRo�ECT ao�REss: 16837W MAPLE TERRACE DR Pipe Material/ASTM Standard(Tables 384.30-3 8 384.30-5) NSanitarySewer: / BM Symbol: � BM Elevation: �� FT Force Main: / BM Description: BOtt0111 Of Sldlllg Indicate north by IMPORTANT: Slope Gradient(%) Well Symbol(if applica6le): � drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. �v-�rz.c.F.t.� �c�`b- �i31- f�l - 57�2 SI°I, T�� Qo� w �a�o `Tawn o-� �.dg-e.wa�-er / �� _ ��.�� I ��7 c7c�a�� w�i-2Ser C�nc�e}e��►� �L � ., , l�eSk�►��r � ta+• t.cfJ"�. �LI �.��!�;I jj','�� fhail not be createc 2+r��`�`"�S °�" ��10� b`^n��s �z�ww ,�ssory struct�er, : � ,� � ' D � yny,, °�,- . � 4 `o- � �� "� �o 0 �.. _ _ � s S`�^�f a I O J G�D �Z '� � � e3 � t c �t � s , 7 ' � � rc.v i S (3 u�-�-�r-�i e,A� w��rzs-� �oSZi's-1 q Septic Tank(s)Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA wieser concrete Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s)Volume(s): 3-ft Trench (down-sizing credit) �000 gal gal gal gal Effluent Filter Manufacturer: , BeSt I min.12° Effluent Filter Model#: GF�O-H Geotextile I (typical) Cover soi�covER TYPICAL TRENCH '2 CROSS SECTION VIEW min.trench � s • depth L ' (ryPical) — —— ,-��,.. �:::;� (No Scale) r : . ; . . OBSERVATION PIPE DETAIL / J� (No Scale) ' n..� + • Screw-Type or System Elevation =� ft. • : Slip Cap(loose) W WW.�� Finished Grade (typical) � ' Provide minimum 3ft (mulched&seeded) separation between trenches. a��Pvc P�Pe J' ` rop5oii Cover Top of plpe to terminate �'� (min.1 foot) atorabovefinishedgrade . �a��ia°-vz^x s°siots TYPICAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) �sb apart PLAN VIEW Anchoring Device Infiltration 4�� Observation pipe shall be installed Surface (No Scale) atjunctionbetweentwounits. ft Perforated Lateral Observation Pipe (typical) (typical) (typical) — — — — — —— �i�— — — — — —— — — — — —— — — —— — — � —— — ——— — � I =_____ _______ _-__= I A — 3.0 ft � -- --- ------- ------- — ^ ____ _ t i�a� uJ � --- - -- - - - - -- - - - �� ---- - --- - - -- -- J cvP � m �- B = 70 ft — I G,) (typical) INSTALL PER TRENCH: EZ1203H Bundle � (typical) � 7 10-ft bundles @ 50 ft� EISA/unit-350 ftz (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. + 5-ft bundles @ 25 f� EISA/unit= ft2 = Proposed EISA per trench = 350 ftz Required Infiltration Area= 643 ftZ Distribution Method: x 2 trenches = Proposed Total EISA = 700 ftz branched manifold � 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),Wisa Admin.Code. Maximum Dispersal Area Operatinq 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 Iateral 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 Seqtic 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(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 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 1'L 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: BUtt21�1@ICI, �I1C. Phone: 715-634-8�76 �ocal government unir. SaWy2f COUllty Z011lllg Phone: 7�5-634-8288 �ocal govemment unit address: �OG�O Malll St. SUIt2 49, Hayward, U Z�p; 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. 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. Svstem Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. Redl Estate Sawyer County Property Listing Property Status: Current Today's Date: 10/25/2022 Created On: 2/6/2007 7:55:16 AM �Description Updated: 3/17/2022 -i'Y Ownership Updated: 3/17/2022 ._ ..._ . . _ . ..... . . ----.._._._.__..... Tax ID: 8722 JORDAN L&]OELLE E SEDIW �� CHIPPEWA FALLS PIN: 57-008-2-37-09-19-5 OS-007-000020 WI Legacy PIN: 008937195702 Map ID: :7,2 Billing Address: Mailing Address: Municipality: (008)TOWN OF EDGEWATER ]ORDAN L&JOELLE E SEDIVY ]ORDAN L&JOELLE E STR: 519 T37N R09W 1797 198TH ST SEDIW Description: PRT GOVT LOT 7 CHIPPEWA FALLS WI 54729 ll97 198TH ST CHIPPEWA FALLS WI 54729 Recorded Acres: 9.200 Lottery Qaims: 0 First Dollar: Yes � Site Address * indicates Private Road ._._._-- ..._. ... Zoning: (A-1)Agricultural One 16837W MAPLE TERRACE DR � �� BIRCHWOOD 54817 ESN: 430 U Proper[y Assessment Upda[ed 6/28/2021 �� Tax Districts Updated: 2/6/2007 Z022 Assessment Detail �� 1 � �� State of Wisconsin Code Acres Land Imp. 57 Sawyer County GS-RESIDENTIAL 1.000 5,000 19,300 008 Town ofEdgewater G4-AGRICULTURAL 8.200 400 0 650441 Birchwood School Distrid 001700 Technical College 2-Year Comparison 2021 2022 Change Land: 5,400 5,400 0.0'/0 �a Recorded Documents Updated: 3/17/2022 Improved: 19,300 19,300 0.0% � WARRANTY DEED � �� -�-� -�-�- Total: 24,700 24,700 0.0'/0 Date Remrded: 3/16/2022 435338 � TERMINATION OF DECEDENTSINTEREST � Date Remrded: 6/6/2007 346897 �Property History .__. . � WARRANTY DEED N�A... .._.. . .. . ..._..... Da[e Recorded: 8/30/1991 225014 /�""='�T�"��'�. PRIVATE ONSITE WASTE TREATMENT �ounty �-� i��'i�o$ `\j�'� SYSTEMS sa.W er ��PS�' ( POWTS) Y �ry�F�--�� >s""y^='- INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION ��_7�� Pe�onal infonnation you provide may be used for secondary puzposes[Pnvacy L.aw,s. 15.04(l)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#� n` � �t� � �-'Jo�e N �w Insp BM Elev: BM Description: Parcel Tax No: (a-�.a' �b�. b�s;�� a��- `�7— (9- S7o� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,�„e � �O Benchmark (oo,o' Dosing Aeration Bldg. Sewer �7,q ' Holding St/Ht Inlet 5 3,�Y ` TANK SETBACK INFORMATION St/Ht Outlet �3,�j � TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic ,}{�o' '� -�1 .f.c�-p� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. .Ya � Holding Dist. Pipe PUMP/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 INFOR ATION DIMENSIONS W 3 L gD 'gd #of Cells a Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber o AG � EZFIow Model Number: CELL TO �'(�o -�-� .)-�� o Mound o Other -- — --- - —_ _ — --__--- - --_— __— DISTRIBUTION SYSTEM X Pressure Systems Only - ---_ _ __ — -- ___ --- Header/Manifoltl Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac L Spacing ❑Yes ❑ No — --- SOIL COVER - -- - —- -- — -- -- Depth Over Depth Over 1 Depth of Seeded/Sodded Mulched Ceil Center 1 Cell Ed es � Topsoil ❑Yes 0 No � ❑Yes 0 N� COMMENTS: (Include code discrepancies, persons present,etc.) ��'hST�l(2� �-2l�I �-o� . �— ------ Plan revision required?�Yes ❑ No 03 (3 23 � ��„ � � /� �� C� � Use other side for additional information Date POWTS Inspe or's Signature Certification Number SBD-6710(R.3/01) ADOITIONAL C�MMENTS AND SKETCH SANITAAY PEAMIT NIJMBEA:�=��_. i ? �(o� � � � � i � wl�. // ��gb . � _ ; __ . . , _ . .__. , �� o �� . � � ` � �� ` � ��,s��}c��P��C'. ' �, �— --; _ � _ � - - � : --- __ _ _ k�° ` �'Y�� '' / ' , _ ; ; ; � . , _ � _ _: _.. _,__ _ _;. ,._ ,. ._ ___ o� ' , �o � � � ' � . __ _ _ ,. _ _ . I ��S I o�o �� P�� s�� . �S � � � � � 9 � Habitable Living area � I I�� ;hall not be created b - accessory structures ��- � ��