Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
002-940-10-4301-SAN-2023-029
� SAWYER COUNTY ZONING& CONSERVATION ADMINISTRATION � 10610 Main Street, Suite 49 Hayward, Wisconsin 54843 � (715) 634-8288 '�'' � sanitarian(2 sawVercountVgov.org fJ �� COUNTY SANITARY PERMIT APPLICATION � In accord with Chapter DSPS 383,Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRINT Property Owner's Name Property Legal Description � ��Z GL�'/< �'/4, Sec. �� ,Twp.`{ � N,Range � W ��:a51-�t� ; �c Property Owner's Mailing dre s Lot Number Block Number r�-� y�•� t„1� ��,q.,,.; �� City,State � Zip Code Phone Number Subdivision Name or CSM Number (�-• ,,,r�,� �,..�,. .- �I�, �.l 3 c � TYPE OF BUILDING:(Check one) ❑ State Owned ❑City tvearesc xoa�l l�� `�N,5 ❑Public [� 1 or 2 Family Dwelling—No.of bedrooms 3 �vivage ���y /��� Fi e Number�r � Town of ` _ PUBLIC BLJILDING/LAND USE: [Explain the use/purposc for this Parcel Tax Number:(12 digit legacy number) permit,(i.e.,campground,festi�a(,recreation/entertainment event etc.)] O ��- _� Nd -� ?-� 3 � � TYPE OF PERMIT: Additional Information: [�POWTS Reconnection(SAN#�- IJ�.) ❑POWTS Connection (SAN#_- ) *Attach a Plot Plan with all required information per SPS 383.21 ❑POWTS Revision(SAN#_-_) ❑POWTS Repair(SAN#_-_) *Soil Test Information(CST# ��- �7�) ❑Other: *Gallons per day�� RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the insta]lation of the POWTS activity for which this permit is issued. Plum s Name:(Print) Plumber's S' atur Y PRSW No: Business Phone Number: �� ,� �,n�� u S 3 �J � ��s> �IiE - IG �l � Plumber's Address(Street,City State,Zip Code): � I L i� l�/ �� � �,� ,v - � t„/ S y g v I OFFI USE ONLY: y �) 2 ❑ Disapproved Re��iew Date: Permit Fee: Date Issued: Issuing Agent Signature e�APProved ❑Owner Given Reason for L1/11 Z� (�.�O �'t� ��3 4�.1����q�"—7��"�" / L 9— COMMENTS: **Expires 2 years from date of issue** Expiration date: "j�i�-p':�-� CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: p � � ,a����i 1_��-3.�------�.- �_`� '� APR 0 3 2023 ` � ��GI ��k# bo ��______..._ _ (1�r�'S1 � :: f�o S _ SAWYER COUNTY �"_Y���� ZONIN(�ADMItrISTRATiQ1( Rev.04/21/15 30(0�1 NO R�FU�lDS AFTER 15�UE OF PERMI'( �.Q� . £p �rtR P0.oPE67Y LINL� yr� 6 ��� ✓a c� w o � � A � �� �� � � O Y � �'� � � � x s�� r -s. Z '°►r - �---�� ; �' .. , .� 4..� _�.,.j_"-_' . �� m � N 'x � �'�i rr ^ C p � � Ew o P y � s (!� - a-� o � � j .� n �' s o d, p 'r �i °� 0 m a M � � a � '� 3 P � � „ � p .� r � -+ 3 �'0 ,i, p s � � rn m nN, o � ^ � r o N m r n ` < � '9 • � 3 � o G �' P r o � � --' �; ,� � � � � 2 r .0 O ' 1 ,� E O O i � �.� � .. . 'i ' .�. a � .0 '� �q o U` ..0 .? o � � o � { a ° Z G � Z Z � � a � n �, £ f ��"'�►4r� c�ounc. :� ; ��'� �'�;� Safety and�ujid�ngs 17;vis�on ,� ��. '�' �.,,., ,�'' �� " 2�1 VZ{.WSShi�9t4�t AVB,,P.�. �OX 71�i2 S�nita€}Nerntsi Num�r ca bc fillcd in b3 Co) , I ��i P� � Mad�son,W! 537f�7-7t62 � • � �:�� �J�'� /� �7f� 5"5'!�l C!�-� . . . .. ' � . . . SiWIC�`f8t1`.c�t2Ttyti�iV(T1�Cf� . . .. . � Sanitary Permit A�plication ;� in:uc;xcl;jnce�a+tJ�SI'S i$.i'_It�),4�'iti .1�im C`c�dr.si�bm���wai«i tizi�tiatm lu th{appn��tttuic�;ats�rr�n3c;}t�)iinit � �ti r4��u��rc����i«r[«uMru�rvrag n+atniuty��n�ut h�te'Ap��irr��rrHt ti�arw�,tt+r,tutc-e,i�rud['t71b°i ti�r�se�bn4ttit�d tu� Prnye.it���ctJe�4s��'tii'1rF�rl�cnt t�ww���xiaii�na uddres�) � �� �� ttse Uc�ttmrnl is('ti;�Ccty anJ�'r�fe�tiion�!Scrvie3 Pr�acral mf`s�rnua�on os�u prcavidc may 7sc i�sed for seu��lary , ur 35es�n accorrGuKr uith thc Ynvacv�t�ti�.s i�fW(t m.Stats. --- ,,r��r+,r,� - '�' l,�A,,js�tlir�tirrn,(nFrrrmsNic�n�Ple�.se Print:1t1 inf�rmatinn �` _ �____M__..,...,,��_.____.��,______... _.__.._.._..__T.,.. _ ��_.__..,.�.__ _.._.__-___ i}rn�xrtt�f hvnG��lYtuetc pzir�a#1� � k�..� a. �ra r �oa -9�aa- fQ ��o � t'tnpct#y(hvncr"�Muilin�;AdJrc�s '� F'mprtt}�l.�tiralrtm .��if3. i;�r�t,t.a[ . ,.__._. f'ity.St€tic %i�r Cak Pttt}ne Num�r __45�.�_�' �..;:�_.%"�. ticetic�n I 4 r� _. ' �;-t'��/3 t�«���4,� � .'�� �. k_ .`�,_ �--< <ti� � 11.'!'��re of 3uildia��chccl:�!I th�ti appi}) t�:� �� .�...�.�....__.�..�.,..�.......�..�___., ��i�r�F'umi{}TA�eilin t�te�s�ber�af[3�clrrx�ms'� Suhii��i�can�ari� �— �� ��___. _.�__. ESk��N ' � �Nuhlt�'t'na�mrr�;iut�1}e�:rtt�L��: � • � � �, __ «�__._.. �C�tv t�f � (�titat�f lwnc�4 C?csrri�r thc t 4'�1 Nurrrl�r �Vi[{a�r nt�:: � � __ _.__� .,�.�__ _ _ _� �_..__»._. _ G�K t t� ltss��tol _.�.�.4j.S .� _.___. � I t11."1'y�e nf Permit: (Cbeci:�mis�one iwx on Tinr rl. Cnm��icte line ft ifappiicabte} �I � r3_ �:� S�r�s S}��tcrn �Ftcpl�rc�rncnt Syslzm �'i r�tme�}tIH�oM+r�iac�k Re�?ttfcrnicsnt Oniy (�l)tttrr h1<xttii��turn tc�►:x�+tin�tiysirm texn4��n} �. �f'�r���i3 ftc�tc�tal �t'vrniiE f��vi�n�n �(:twn�tr nft'Ieu�iExt �f'ecmit`i"rumfer tc�?�e.�x I,�tit t'r�v�mu I�etmct tdt�mtarr and l)atc lssucd � E3�tbm t�tpir;ttl��n � t)wr�r —I�'"'(� � � f� .:�__��-.��.�:.------..-� i�..'i'f �rt f t)1!'"i'��a` rirmiC'tun` nentlt}evice: tC'hCcl:alf ih�t a s#t � � �!Jctt�-#'trx�ut�zeclln-C+rcaunc7 i Pre��urizcd tn•(irix�ncl L.7 r1t-(ira�ie �'tlound-'�4 in:bf swta�Ie soil ❑htctuncl�?a in ni`itr�tr�hlc u�il �l itotditt� I Js11� �tJihrr t>�s�xrs:a{C?€in��>�i��l{t���s��l._._..�_._.��.�. �. _._..� �.9�'YctsNaSmcr�!I�viCr 4��pluuiJ _ �'.1)i� rsai/i`rcutment.•+�r�a lnformation: 1�.1 . De 't S Nows la�3 ' O w�+� iE c.► 4�°t �f� fh;t��;tt f`t<i�c tzi#�+1) 1���,��.n 4v�t A�a��iicat�sen it:i.t{�pc;�)} {}sc�ervtl e1�rs RY�turc�f�tl 3 i7�s�ara�a!hrea Ikt>�x3sc�.1 Scil ti+alrt�t f te�afu�n y�c, �.� � � � ��� �Ex��;;� g ► .ga �� 1'1.'1"8nk ItsLrt �apa4�sti m `1"t,tut N at' h9anufacturer � � � Ga�tutx Cr�llom � k7aits � � *� � :J � � r ti�w'1'�reA� ..t.�„i�ns:taaks � �' � ',S � u ,c � r"3 . .. . . . . . �G.u �;r� u, cr w���'i.. G. Sc��t�c ixlitddm�`f�rk (j�U<J -- �C3v 1 ' � t+» rG�G �_w.- thAvi��};E'lfgmhrr� Y11,Res t�►ncihilit�4tatement- l,tke nndtni�ned,.raxume . nsibility tcrr insta#' tio�oFthe IK11t''I'1 shuwn an t#e a�t�che�t piaex 4'tumtx:e's Name SI'rintl Pluml�r' i, t�irc . �4�,^.�1PR4 Numl�er (3���;ir��s Phr�ne Tvumher T"c-c,.�' ,s�t r�r',e t� > �._ -`�.--_,.r ta s z 8�9 �'t ""-�3'1-$i'? . .�..._. ._.�... _.._.... #'lumixr's,\d�iir�t ttic�e�t.�,t�.Stst�.Zip C'cidt) � � 1�' ��a ,��a,�c �,o� '7� !-1 c► . fi w� S�I 8�13 \'IIL C`�runtitlk�ar#mrnt t:+e On1c Ycrmd I•tr [�:�ir lssuecl lssuatt�;Ag��t�t S�}�rr3tutc (�A�psta+�J ❑ t7iv�{�ttttiti� � ��1 ,}- 1 ❑C_h+ncr G��rn Re:iinn li�r Flen+:�l ��t1.�'� c#���- /..`�� ���f. , �!!u�i K'i�� � ��`1;�.C'�nilitit�n;�af tlp�srnt•atliteasons itar�t?ixa��rQVF►1 � � ,L;3 RE������ ��SU� A#tath to wmpiete ptads fnr 2ht s��tem aad su�mPt to tfir C'ainty anty oa}�per nat{�x+thsn tt rh+c I!inchn in aite 5SD-t�398 4 R. U I I f} ���y'r• �'Fs:�',�� (.('r'.A.' i'� , ` £{ h � � � � � � � ; � � -� �Q �'' � , --� �,�. � ,�� `�A � ,,.,� � � Q � rr ; � , ��` � ._. ,� t � ��';, � � � �� —� S � � � � 4� � c� � �; � �� � I _=- � � ' ` �� � � ; � � � ;,;� � , ,i � � � ��� �� � � � � �� � :��j .�-- 1,� � � , � V P ~, ��;' '�� —� � 1 � � � � � '� �`'�. _ ��•� � � `�� � � ,, � � -� �� ,. . ,� � , �.� � � � " -c � i ` � � � 4 ' -`4 � �` ` � � � r- � ` � �a � -�, � � �� � � � � � ! " _.�-----�-.s:_n.._...._.,.��.,�: �J �� �� �~� ��`4� �- 1 ~. � "`-- ���.f � ��, �� � a � , t� ,�, ,.� y `� �;�` �__�- t ,� � / �° = ,� ; " k � / �_- � . � ; �z���,. ��--- � , �y - __, ����� : � � � � _,�---� � �...w�_ } ! �, . . � � � ri � ,, , ,f-�...... ;. .�.- - � � .,,�� � � �� � ��� � � � r��. � � ry �' � �� � � h � �� 1 !ji j�l4 � �� t.'+; �j �'!" }. (l�� t�-t � �� t {�a�i 1� [�}� � �(.� ! ��4`�\� �� � f ST f' �`��� ���-- � � � � �� .. � _ ,_ _ , . . }, ���a{ � , `. 'E,� �';:1 P.�s .i i�1�., i.���:�1. .�v.�'.i� � i`a .. .. ��� ��� �, �,�y� aF� ,:,�r � � `��:� �� � _ :l�� � �'• �s�, �� � � 9�� a��,, ,ti ,� �.� , � �` ��. ; �_3 ,�;. , f ' � , � j i � . �� �7 � ' � � . r i�l� � � j � � / +� i, j �f��� ,� , � � 1E �, , � �,�� y ��i�`' t f# '� 1 'f ,`` ! ,�<= � �, � � � 1 �.-F', / �--- ��- �� �' ������ � � .- -�"y� t ..�.--=���` _ ' �..e....,..�-� � - `�- �.� .:� �.{ � � .. s .' . � �)��i�'�l . S�wy�r �our�ty �onin� Adr�inistration , IU51(l:�1ain Street Suite 49 � ���.�►���� I-layw��ec�, Wis�c�nsi�� S4�i43 �.�ER ��j�+t {7i5)t:33-fi?xR �„ve�- _.+�►t 4�A?t t"15�+3t�-3'_�7 .r"G' .�! sc:ii+. z�t•r�i eit��t�G�sr�� . �V`i' ..:.°CI, 1:-tlWtl.�i��7zri,,,,_t-.,?�a.}tr� �t�[�i_yt,Fr� ��5 -- � ^ �� Y'al!Frrc C'aurttt�ustt(,cncral iaforrtu[Ic�n!-B'7x-h99-4 i tn . . # s.�..,r �:r`-a ��: _ . . � . .��.` r { � a' r # t r A � � � . . . �,t;{�{A1� . .. . . . 1���4 SA�'�ER CC3UIV4TY ��i,NITAT�ON DEPART�i�1�iT "t'EM�'C?RARY EM�RGEN+GY TAi�xk t�t�`CALI,ATit3N A►PPRQVA,�.. P�t(7P�:RTY C�1�VNI��.S N��iC: .��ve� . �.�..CJ �c���I:__ � . TQWN t�l�: �.,5�..._.�rc�,_��� A�DRI��S: I '��' �� O � �: �1 ��.-M� RC v; ,� �,y '}" '�"C r t f � �� .a Wis��nsin j�.�.:_�_.�..�._.� ��_-'--�— ___--- _. Liccnsed Plum�er, authnrizc;d by thc c»�ner,C�t7 I14'�'4'�V�CICT101��1ed�e that 1 �tn rcctivin� t4txtpnr�y a�p�c�val ic� inscall a s�piic tank/hc�ldin�tank uithout a sc�it and s'rte cvaluatiQn, flr exrstin�syst�m evaluatit�r�, and�rivate setiva�e system plan revie�v due ta inclement wezther:�n�/ar he�lth at�cilc�r saf�ty em��gency. Further, 1�t�laiawled�e tM�t�sail and �itc evaluation, ar�x_istin�system evaluation, and ��rivatc :��wage syste�n pl�n revie�� will�c conductecf hy the d4a�iiinc�ti:�ulateci h}�tlte �rmit i��t►in�;��ent,c�r��s��on as�vcatl�cr cc�nditit�ns ar circuntstances permit. If'the �rivate sewage system is found to be failing as dc;fined in s. DSPS 38I.t�1 {92), Wisc. .�dm. Gc�de,cr�rreciiv�m�a.�ures��°ill he:taken as su�h that the privatc: sc:wa�L system cc�n�plie��rith atl apptica�t�r�quirecnent5 ut`�:h�pt�r[�5F5. 3�3,Wis. Aclm. C'c�de. within 90 da�s of this a�re�ment. ��urther�eknt�wledge tttat�failure to cc��nply by ohi�ining atl necess�ry pen��#ts aFtvr thc deadline clate m�y r4�ufii ir�il�e issuing c�f a citatinn,under Sec�i��n 11.3 [2J Sur�itut�� 1'c��-mi�s],ofthe Sati�yer Cc�unty Citatic�n Ordinancc�, , � DEADLINf; �t)R THiS ACRE�Mfs1�tT SF�ALL C3E:: �"' (`� ---�-��_�____._�_�.__._ . " �. . ��� �i�n�d: .•°-j"'���/�;"� �. �`��.�� �5 ._ Date• : Accepte� k�Y:�v_. �_`�'� �t',`'����+��'' �..o�._.�_._..___,_��.__. T}ate af��mporary emer�;�ncY aPproval.���#�I� (tev. {l3/2fit 1:� �' ,, PRIVATE ONSITE WASTE TREATMENT cou�b �oap.,: SYSTEMS Sawyer �� -s. (POWTS} satery end eu�romys oi�sion lNSPECTION REPORT San1fary Pertnit No: (ATTACH TO PERMI n GENERAL INFORMATION �S— �ao Pasoml infomiation vide� be used for a Priva Law,a 15.04 l m Permit koldefs Name: Cfy Vltlage Torm of: State Plan Trdnsactlon ID#: �p,v�ev�tNatG� �.¢.o.-.a� 55 �ak¢.._ Irop BM Elev: � BM DesufOtlon: p Parcel Tax No: (EX7 '�'o o-�'ok{(�'� ��sw- ,:al Do -q�Ee-lo-Y3o 1 TANK INFOR ATION ELEVATION DATA TYPE MANUFACTURER CAPACIN STATION BS HI FS ELEV �py� � ppp Benchma�k D, f .6a� l60�0� Dosing Aeration Bklg.Sewer .3b' "i S.2b` Ha�ing St!Ht Inlet � S�� TANKSETBACK INFORMATION stlHtounet 6� 45.p TANK TO P!L WEII BLDG �IM°� ROAD Dt Inlet SePtic i7ai f oo' .r3o� NA Ot Bottom NA �nstaNatlon Dosin9 Contair Aera6on NA Header!Man. Hol�ng Disl Pipe PUMP!SIPHON INFORMATION �nfiltra6ve Suttace Manufach�rer ��� Flnal Grade Model Number GPM TDH Lift Frkliai Loss Sys Head TDH Ft Forc�nain L Dia Dist To WeB DISPERSAL CELL INFORMATION DIMENSIONS W L !�of Cells Typeof System Disb�uuon h7e�a Manufadurer: SETBACK OHWMotNav o Conv ❑ Aggregate P 1 L Bldg Well wa� o IGP e Chamber Model Number. INFORh1ATI0N ❑ AG ° ��0''9 CELL TO a Mound o Other DISTRIBUTiON SYSTEM x Pressure systems oNy Header!ManiFold DisNbudon Pipe(s) X Hoie Size X Hole Observation Pipes Lengtli� Oia_ Length_ Dia._. Spae_ Spadng ❑Yas �No SOIL COVER Depih Over DePih Over D�th of Seeded 1 Sodded Muiched Ce��Cp,nter Cell Ed es To 'I ❑Yes �No ❑Yes ❑No COMMENTS: (Induda code disaepandes,persans present,etc.) ��.slal�� os�a9�c s� " ST� or� Plan revision required?O Yes O No D+ ,2, J(o ��wLCiC�-� � �9'�l� � Use olher side for addfional int�rmation Date POWTS inspectors Signature Certlfication Number S80.8710(R.3/01) In-ground Gravity Management Plan �. IMPORTANT: The oNmer of this in-ground grevily system shall be responsi6le for its perpetual operaUon and mafntenance pursuant to requirementa ot SPS 382-384,�sc.Admin.Code. Purauant to SPS 383.52(2),Wiec.Admin.Code,this syatem shell be conaldered a human healfh hazsrd if not maintalned in accordance wllh th(s approved management plan. Furthermore,all inspecUon and malrttenance activfdes shatl be perFom�ed by a registered POWTS MalMainar in acoordance with SPS 383.52(3),Wisc.Admin.Code. Maximum D(s�rsal Area OoeraUna Limks: Design Flow= 450 gPd; BODs 5 220 mgL''; TSS 5150 mgl''; FOG 5 30 mgl'' inaosction CheckNst IN$PECT EVERY 3 YEARS o type�use o ege of System o nuisance fadors(i.e.odors,user compl�Ms,etc.) o mechanical malfunctlon(Le.,pumpa,valves,switches,floats,etcJ o materiel fatlgue(l.e.,leaks,breaks,corroslon,etc.) o solids voiume in aneerobic treatrnent lank(s)ar�d arty dtstribuUon appurtenanee(s)(i.e.,disdibudon I drop bwces) o negiect or improper use(i.e..excee�dng design capedtles.prohiblted acdviUes,etc.) o exterd oF ponding in dlsGilwtion ceil prior to do�ng o dosing imegulariHea-H applicable(l.e.,pump re-cycJing,floet switch setdngs,efc.) o elecUlcal components-if appilcabb(l.e.,wiring,connections,switches,controls,tlmers,aiarms,etcJ o dietributlon lateral or Iaterai oriftce plugging (measure lateral dstal pressure—compere to design speGfica6on) o sutface discharge of eflluent a sewage back-up into structure served Ma(ntenance Checkllst MAINTAIN EVERY 3 YEARS(or when necessary) o Sectic and dose tanklsl shall be pumped by a ceAlfled septage servicing operator Iicensed under s.281.48 Wfs. Stats.when tha volume of solids In the tenk(s)ezeeeds one-thlyd(113)the Itquid volume of the tank(s)w es requlr�!by local ordinance. Disposel of contents shall be pursuant to NR 113,Wisc.Admin.Code. o Eftluent filtmisl shell be inspected every 3 years and shall be deaned when necessary to r�nove any aocumulated soUds aocording to manuFacturer's specificatlona A servfdrtg period will�ways be greater than 12 months. System maintenanee repoRs shall be submittad to the proper local govemment unk in seco►dance wiM SPS 383.55 Wtsc.Admin.Code. RepoR arry component failure or maltunctfon to: Name of individual or oanpany: BUtt@�1@Id,Inc. �,a1e: 715-634-8176 t.oc�9wemmenc uNc Sawyer County Zoning&Conservation �1Ote: 715-634-8288 �9o�e�„eM„�e�aaress: 10610 Main Street Suite 49;Hayward,WI Z�P. 54843 My detective paA ot thls system shali be repaired,replaced,or removed pursuant to SPS 383.51(1),�sc.Admin. Code.Repair or replacement of failed or mal(unctioning components shail comply wfth SPS 383,Wisc.Admin.Coda. No product for c�emical or physical restoreBon of lhe POWTS may be used unless approved by the departrnent(n axordance with SPS 384,Wisc.Admtn.Code. CoMins�encv Plan In ihe event that eny failed Veatment component o(thia POWTS cannot be repaired,tt shall be replaced pursuent to a plan submitted to the appropriate agency for revfew and epproval. A failed in�ground dispersal component may be abandoned and replaced by e codecomplying dispersal component in a pre-detertnined area oi suitable sdls. Svstem Abandonment H use of lhla POWTS fs discondnued,it ahall be abendoned in socordance with SPS 383.33,Wisc.Admin.Code.