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HomeMy WebLinkAbout010-841-32-2101-SAN-2023-019 � -'��=��"�`%; Industry Services Division Counry � '=�`,�' _ I �� 48�2 Madison Yards Way �w .e� � '.=' �\f p ' " , �1 ��D Madison,WT 53705 Sanitary Permit Nw ber(to be filled in by l ; : ;; ei �:3 P.o.�ox>;a� ����x:,��--,:�% �j Madison.WT 53707 �j7 � �� .�`'� ( � �y„) _ � Sanitary Permit Application Statc Transactio�Numbcr _ } In accordance���ith SPS 3R3.21(2),Wis.Adm.Code,submi,sion of this foim to the appropriate govemmental unit �— O is rcquircd pnor to obtainin�a sanitary permiL Note:.Application fornis for stato-owncd POWTS aro submitted to Project Address(if difterent than mailing a � the Department of Satety and Professional Services.Pcrsonal inli�rmation you provide may be used for secondaty � purposes in accordance with the Privacy La�r,s. 15.0411)(m),Sta[s. � I.Application information-Please Print All Information �� ��� � Pr pc�ty Oµncr's Namc Parccl# � �� L�.n LL� B� �! . 14s�� C L�g��v-e. � ora-B�!_3z �- z�D I Property Ow•ner's Mailing Address Property Location �o r �'Br;,�, ;l( �. ���- C'nV[ I n�r -- City,State 7_ip Codc Phonc Number ., F 7 �C�. 1,e.74Y`� W � ��B lJ �z—��Z-63�� I�/�%'<. N�'/., Section J Z. ii.Type f Building(chec all that apply) Loi R T N R O Eo �I or2FamilyDwelling-NumberofBedrooms � Z SubdivisionName Block i� `' ❑f'ublic/Commercial-Describe Use _ �City of ❑State Owned-Describe Use CSM Number � � illage of _ �- 1�2'-�� 1.,1�-f _u T<�„m�r� ��-►�c.. v_ _ iii.Type of POWTS Permit:(Check either"�Tew"or"Replacement"and other applicable on line A. Check one box on line B.Compiete line C if a licable. A �ew System nReplacemenl System ❑Olher Moditication to Existing System(explain) �Additional Pretreatment Unit(explain) '�"" LJ B' ❑iiolding Tank �In-Ground �,t-Grade �Mound Tndiaidual Site Design Other Type(explain) (com•entional) C• ❑Renewal Before �Re�ision ❑Change of Plumber �i'ransfer to New Owner List Previous Perniit Number and Date Issued Espi ration •— IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Applicatiun Ratc(�.pd/st) Di,persal Area Requimd(st) Dispersal Area Proposed(,� System Elevation r�-so �� h`�� � q Z �`I��S Capuciry in Total J?of Manufacturcr Tank Information Gallons � Gallons Unils � ` o ? c, Ncw Tanks Existin�Tank.e ,� � � � ` C � � � � ti O � c. U v: ,n r/7 .� i,i � "' Scpti orHoldingTank OoO ��, �Dhh I �i�s��- lJV Dosi�g Chambcr � � V.Responsibility Statement-1,thc undersigned,assume responsibility for installadon of the POWTS shown on the attached plans. Plumber's Name(Print) Plum , uture MP/MPRS Nwnber Business Phone Number Ro 6 (� g 4��r-�. � L z(aZ � g -r�S-b�t�r--�3 Plmnber's Address(Street,City.State,Zip Code) I�4��q W sf. f� `11 �� �4r c�. � 1 5 �y 3 VI.Coun /Department Use Only �A o` ❑Disapproved Pennit Fee Date tssued Tssuing Agent Signamre ❑O�cncr Givcn Rcason tor Dcnial S `�"� ' �I � I�� "'1'�L��"� /"'_-""' ConditionsofApproval-ReasonsforDisapproval __ �-.,� � t r-- ��-�� � 3 ':' 1 ` ` __ 7 '_�`"1 � ,., 1 i� � ' ''���`.*____� '-`-' �=� � � � r� ' y�'�,<:�. �`J����-{ , ��"11 - _""""__... � � � �� t�AR 0 7 2�23 f��I..i i/�/O f�c� C S� �� — O�'{�> _ '�� SAWYER COUNTY �RS:S�. IN�STRATIOM .4t[ach to complete plar.s fm�the system and submit to the Cnunn�only on paper nut less than 8 u?s I 1 inches in size 11�3� SBD-6398(R.02/?2) h�,�� _�, PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manua/Design Refe�ences: 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 OwnerName(s): ae�'1, �S��G-r �-� ��r�G Phone: �Z -40z- 63Q( OwnerAddress:(05�b� N. a��r�en �;�( � �-�-���..>a..�Zip: 54848 Project Address: p v� r��z�r R-ca. Govt.Lot: til C 1/4 of fV l-t.)_1/4,Section�,T_�_N-R 8 E❑or�❑k Township: -��iw4-`^� County: Sa w�e�.-- Project Parcel ID#: (7 10 -P��-i� _3Z - Z( O � Designer Information Designer Name: �\Ob ��avC� Phone: ��S- 6�t�- D9 3(0 DesignerAddress: �4Sycj l.J S'�� ��- ��1 t�t�-�-,�-�L, Zip: S`-�8�-f3 E-mail: License Number: 2zCp 1�Qj Remarks: Signature:���— � Date: ��7�ZoZ3 Original signature requiretl on each submitted copy. z/� owneTs L�4-�: �g �-a� � LLC S4�„�ev- Co.� l�a�.�xaw� T�...r� IDSbI N b� �C'�e� I{�,"�( 2d �In� olb-S�Ef-3z - zi ol �-�c.�w4� �� W I S`4S`� '� tiJG/Nt,_7 S� 3z 't" �ili�7 2- OS3w 5��-e : o�. F.��.st� fL-c� Csr'1 � 1444 L�f 2 J. 9 p. z��f�l5 ' _.. .... .... . � Sca.�e �"='-f O� �—� I -- -j � Ip,ro � �3 �C� ,,( ��o� � I o� � Wcll • r 'o � r � J . � �, •� � � ;, h�`_� �, - � �f `, `� �` "� � � \�;;�� , < Se' �c�� t -r- ti-� , �{ ��„oo` +e�-4�� , �� � _ � , 10� zo' � `' aN1 �oo' _ r �. , Fe�se r �. C o W u�`� Q -f'Z°p �l � 4� YO� OT �'OPc�� 1 �%1 IJE 1.0Y✓�PV`� Rl. �oo,z5' z. �oo .e� _ � __ � , .- ., ..�,__ I „ , 3 • i ob. �f z , ,� so,ls s�s�..� e�. �,�'— 7S [, r�vtg� 43.bZ'_ �i'�`:�S '�- ':::i , . �- w�-U �-, M�+ �d� s�-bKs IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manutacturer: �( e..St �c--� Stepped Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) Septic Tank(s)Volume(s): � �o�gal gal gal gal _.__ __�11 _____ I �� ^ I � IC Effluent Filter Manufacturer: SOIL COVER `/� � � ` min. 12" (ryplcal) Effluent Filter Mocfel Id: SL� 12" min.irench TYPICAL TRENCH deplh CROSS SECTION VIEW �n'Plcap •'. a - _ _ ____ - -- � • � �° Provide minimum 3 ft a °. (No Scale) �.�_ sa° � '--� �a � separation between trenches. ��YPlcal) a n . a ,. . e. a I-lighest Trench Lowest Trench (as applicable) System Elevations = �S.Zs ft. cf S. zS! ft; ft; ft; ft , C�uick4 5tandard-W w/ End cap Ohservatlon Plpe TYPICAL TRENCH t ical (Show location of inlet / outlet pipe connection on plan view.) (typlcal) � yp � Install p�r manufacWrer's PLAN VIEW ' InstrucUons. �NO SCa�(,'� � - - - -- - - - ,-- - -- - -��- - -- - - - - - -��- - - .# - - - — � �l , �, � � ��;� ��� ?�� �A = 3.Oft ( � � —� ��� ��— �� -- - - - -� - - - - - - - ��- - - -�I, r_i;�` �. ,t,,,. :: . p � � i � ;� (typical) �-- - - — f- — - - - - -- - --� D � - -- ---- - B = �1 C� ft _ � 'n m (typical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typical) � (mfd by Inflltrator Systems, Inc.) --n � �D Install pursuant �o manufacturers instruclions. � ( Quick4 Std-W @ 20 fi� EISA/chamber = 3 ft2 + � Pairs of end caps @ 6 ft2 EISA/pair = � ft2 = Proposed EISA per trench = 34� ft2 Required Infiltration Area = �y3 ft1 Dislribution Method: x Z-- trenches = Proposed Total EISA = � �z ftZ �t r�- � t�'�l 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),Wisc.Admin.Code. Maximum Disqersal Area Ooeratinq Limits: Design Flow= �S� 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 fadors(i.e.odors,user complaints,etc.) o mechanical malfunction(i.e.,pumps,valves.switches,floats,eta) o material fatigue(i.e.,leaks,breaks,corrosion,etc.) c solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes) c 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 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 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(1l3)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 filterlsl 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: Nameofindividualorcompany: Ro `� l,—a ��`�te ` CPq Phone: —1�S'6��"1 — ��3� Local government unit: Sctw`-12`�' GO z a✓Li"�e Phone: 7�S—63�—SZS�j Local government unit address: 10(p I�p (�'�4,�h ST i� y�j �cc��Jc�..0 ZIP: S`t�� Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51(1),Wsc.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,Wsc.Admin.Code. Soil Profile Sheet Owner. �� �«,,,� L(� Soil Tester: {2S, S�. � � I System ElcYat�o . `1`I�7S Load Rate: D•� �36� �T— System Rang�:__ to �� 7'S ,o� � - � � 3 .....:..... . ...... ...... , ..... ...... _�00.67 �- ...... ...... � � loo ... ...` loo.aJ" � . ... ... � ... ... - (ota Y a �--�—.. ... ... ... ... � , . ...... ...... . . ...... ...... ...... ...... q9 ..... ...... ...... ...... ..... ...... ...... ...... D •� ...... .,.... ...... _.... i ...... ...... ...... ...... �g ._ ...... � ..... ...... O � ..... ...... �.� ..... ...... ...._ ...... ..... ...... � ...... ...... ...... ...... Q� __.. ...... ............ .,,.:.. ...,: ��� ........ ..... ..... ...... � .. 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H. °B „ � _� - - N88�26�36��E � 637.62�-- R.�.W. 3T�.69' 66.03'- � '!e � �s I `�. � �� J•, 66� a � s s a �;2 Pc. ��` ! �a� � � MB!^ 26'16�E , 6]0.90' ' I ' � g � ^ � g O N � �`\v` n � � OI � m , a Z 3 _ ,'.�, 2 � M W � �' 2.BZAc. 8 � m w - \i W - a � � m 0 N � � O �/1 O � � N88^26�38��E . bT0.22� I 2 1 P - 3 n 2.T1 P<. 1 i i +i�� Zp'w.�et'.e� o K1� i0 � o^ S 86�26� 36�W s'z° �e9a. f D ��' zoo.00� z \e 190.9L� .S ROA Ne 86� gJ�\t' � e ryo c�72o 4"f 2O W•2`�GO ' S88'26�36"W,134.00 W �'/Od CURVE DATA � � CUNVE Np, CMOIM pEAA�MO CMORO OIST. CEMTql1� µOLE �- 2 N16^!D'21`W 93.l1� 2T0�00'Op" �'�� SCALE I"_ Ipp' ,_(lSC�Nsf�\ V � ; 4C�"IALDL. �� � POUND MONUMENT [ � Vs"�,o� BEARINGS AR BASED ON �� � ��'�N � � 30LAR OBSE TIONS. ` -�� � SET I 1/4�� x 30�� IRON PIPE ... ,,,,,tipp � DENOTES N V4 CORNER OF $�. 32� � g.yq T4�N � RBW. (/LL,UM-YOA. 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Tax ID: 11632 AB LAND LLC HAYWARD WI PIN: 57-010-2-41-OS-32-2 01-000-000010 Legacy PIN: 010841322101 Billing Address: Mailing Address: Map ID: .5.1 AB LAND LLC AB LAND LLC Municipality: (O10)TOWN OF HAYWARD 10561N O'BRIEN HILL RD 10561N 0'BRIEN HILL RD STR: 532 T41N R08W HAYWARD WI 54843 HAYWARD WI 54843 Description: PRT NENW LOT 2 CSM 9/214 #1944 1n Recorded Acres: 2.620 r Site Address * indicates Private Road Calculated Acres: 2.618 � Lottery Claims: 0 First Dollar: No l.� property Assessment Updated: I1/9/2015 Zoning: (RRl) Residential/Recreational One 2023 Assessment Detail �� ESN: 444 Code Acres Land Imp. i G1-RESIDENTIAL 2.620 27,700 0 �7 Tax Districts Updated: 2/6/2007 .. . . . . .__._ .. . 1 State of Wisconsin 2-Year Comparison 2022 2023 Change 57 Sawyer County Land: 27,700 27,700 0.0% O10 Town of Hayward Improved: 0 0 0.0% 572478 Hayward Community School District ToWL• 27,700 27,700 0.0% O01100 Technical College • Recorded Documentr Updated: 6/20/2022 �proper[y History . .. .__.._. _..__.. .---..._.. WARRANTY DEED N/A Date Recorded: 6/13/2022 439639 WARRANTY DEED Date Recorded: 3/7/2002 298600 WD797/419 QUIT CLAIM DEED Date Recorded: ll/25/1997 264594 CERTIFIED SURVEY MAP Date Recorded: 3/9/1983 185993 https://tas.sawyercountygov.orglsystemlframes.asp?uname=Eric+Wellauer 1/1 ' �'""`�, PRIVATE ONSITE WASTE TREATMENT County ���'���a - SYSTEMS ,'��S�s ( POWTS) SaWyer ����, �ry°'�'` t�`v INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION Z�j� �I� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village [p�'Town of: State Plan Transaction ID#: f���.aw� l�� 1'lQ7w� _ Insp BM Elev: BM Description: Parcel Tax No: (do.�� �w.,� � �.�� 9{a�� olo - 8Y/_ 3?- 2t o) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic W� j Do� Benchmark �� Dosing ,(jM� �av,�' Aeration Bldg. Sewer q�s'.�' Holding St!Ht Inlet G'7.r � TANK SETBACK INFORMATION St I Ht Outlet q7� � TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet AIR INTAKE Septic k�a� �/ y �j ' NA Dt Bottom Dosing NA Installation Contour Aeration NA Heatler/Man. QS�' Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface `t'Y Ss�1 Manufacturer Demand Final Grade � �oo•3S Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well _ ____ DISPERSAL CELL INFORM TION DIMENSIONS �N 3` L (og 6�� #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate ��1 INFORMATION P I L Bidg Well Waters °� G .� Chamber Model Number: ❑ EZFIow CELL TO ` �-�.p� _ � N ❑ Mound � Other /;�Y� --- -- ---__ __— --- `i DISTRIBUTION SYSTEM X Pressure Systems Only — — __ -- -- --_ Header I 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__ ❑Yes ❑ No ❑Yes ❑ f�o COMMENTS: (Include code discrepancies, persons present, etc.) �F ���� ���� ��3 � Plan revision required?❑Yes❑ No i��� 2rd 2 I � � 69 � y _� �Cy���__ _ � �� _ Use other side for additional information Date POWTS Inspector's Signature Certification Number SBO-6710(R.3/01) ADOITIONAL COMMENTS AN� SKETCH SANITARY PERMIT NUMBER:__�3 � C��q —J--- _ , _ ._ :_. , -__._ . ': ; _ _--- - - . : ;.- :_____ __ ..__. .__�. _ , . __ _ _. , . , _.. ' _.. _� , ; , � : . ; : . ; : _. . ; ;_ i , ; _ .. . �_ _ ; _ : _ :_ ;.___ , ��. __ _ . ._, _ .. _.' ,� a� ;���� � , c q,� i ; - �3-- -' S� , 3 �i� � ;�_ w �;y,�� P� ��� �°'Y I ,,.�`- �,t p°', � � � QYf' I � I I I � ��I L , � � fi3a oY T �d� ,.� ��r�' `�M. re��v�� �� ������� cb �c . �`� �d�-- `;, _