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Home My WebLink About010-841-32-2116-SAN-2023-032 � V 1 � �� Department of Safety c°°°ry D ,_, � �,'� '��r��S ��t i �i-� � �° ��3 � professional Services, "'=,Y�� " ' � .. � = Sanitary Permit Number(to be filted in by i , �i ;_,i Industry Services Division ��-ti d" � �`� 3 J� qJ �NNi�� State Transaction Number � W Sanitary Permit Application _ , s (n accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit w, is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ac � the Department of Safety and Professional Services.Personal information you provide may be used for secondary , purposcs i��accordance with the Privacy Law,s.15.04(1)(m),Stat,. ��f �� [.Application Informat�on=Ptease Print Alt Tnformation ___(SL�L„ Property Owner's Name �iP 1�tc\ rf. Parcel# � �� .� ri ,N ��. ��`` �r3 �� -�y1-3�-� r� PropeRy Owner's Mailing Address Property L.ocation / O �? � y ��., � n �-r��- � ov I �� City State t �, Zip Code Phone Number � / � H �� (_ /T' j �� `g �� Ya, �In/ '/<, Section� r��r II.Ty e ofBuiiding(check all that apply) L�t# T �( / N R E or C�1 or 2 Family Dwelling-Number ofBedrooms � � Subdivision Name Block# � ❑Public/Commercial-Describe Use � ❑City of _ ❑State Owned—Describe Use CSM Number ❑Village of �zs �$7 �66� � ��,�f------��--- - _- III.Type of POWTS Permit:(Check either"New"or"Repiacement"and other applicable on line A. Check one box ott tine B.Coroplete line C if a licable.) A' �iew�S stem y. ❑ Keplacement System � ❑ Other Moditication to Existing Sysrem(explain) U Additional Pretreatment Unit(explain) B. U Holding Tank -Ground ❑ At-Grade ❑ Mound ❑ Indi�iduai Site Design ❑ Other Type(explain) (conventional) C• U Renewal Qefore ❑ Revision ❑ Change of Plumber U 7�ransfer to New Owner ist Previous Permit Number and Date Issued Expiration �— IV,DispersaUTreatment Area and Tank Infor�nation: Design Flow�gpd) Design Soil Application Rate(gpdis� Dispersal Area Re uired(s� Dispersal Area Proposed(sfi� System F.levation � I �s� � �� 77 y�. 3 � - � � 3� Capacity in Total #of Manufacturer Tank lnformation Gallons Gallons Units � a v ',ti, � � o New Tanks Existing Tanks � o a; � � p ^ � a U va v, �n ij. C7 Li. Septic or Holdi�g Tank ' ',�' D p /� J� , � � j v � i Dosing Chamber V.Responsibility Statetc�ent- I,the andersigned,assum espo ib'ity for installaHon of the P(}WTS sh n on the attached plans. Plu r's Vame(Print) Plumbe�' ignat P', YRS h`umber E3usiness Phone Number I/fic✓� ��Ci 1 � � r�� .J7�"'>�' � " �"�I � ��i�s� Plumber's Address(Street,City,State,Zip Co e I �j�1�� ( � 7 ( �`�lN� � �/�,7�%�-/� -! S� �U� VL C un lDepartment Use Oniy � �ri� ❑ Disapptoved Pennit Fee Date l;sued lssuing Agent Signature ❑Owner Given Reason for Denial ��'�� °' `� I I� I� � -n'��.�.�.`j-f��.,« Conditions of Approval/Reasons for Disapproval � � � � ��.�� . � � � -� ��'''�� . � ��GI �� :��..�. a.J� �. ��,k# o°��`�� APR 11 2023 �- C sT c�y— �Y�. � �. ._...S-.bb �V lJ� �__� i"I"�• _ .... ��% SAWYER CCZL+�� : : ADNI W i81"i-�ti�'u;1� Attach to complete plans for the spstem and submit to the County only on paper not less than 8 tn x 11 inches in size q -7 1 ( �� ! NO R�FUNDS AFTER sB�-639s�R.o3i22� ��SUE OF "' r�r��nir �H� -�' � 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 2022-2Q27) 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): L.,.*��nl �)�� t�-- Phone: - - Owner Address: � t� � `% % ��r.✓ p: � �? �itl(� .�c N S: a- ��Jz� s ��;�� Project Address: .��5 � � �� Govt. Lot: �1/4 of �� 1/4, Section�, T�N-R � E�or W � Township: �y�`C�✓�r� 1� County: �� r Project Parcel ID #: �t� �`1 � 3 � � � � � Designer Information Designer Name: Dan Burch Phone: 715 _416 _1642 Designer Address: N5921 Cty Hwy K Spooner WI Z�p; 54801 E-t7181�: bUl'Cr1p�Ut7ltJlf1gI11C G�gl'7181�.001'Tl �I'hrts:��atie x-e,�r�vecl tc>r:�p�.o al st;�=��. License Number: 253808 Remarks: , � Signature: Date: y � � 3 - � � Onginal signature required on each submitted copy. , � �� 1�t SeF y, ELEVATIO+V 5 �.T 3, ��„��,�,�►.,�,�.e� SC R L E = 1 � 40� . an �oo.00 � uE�M.�+•�,�.3��TYiN�R8W t3� 95.00' TowN eI MMwARO, srwr��t ta�aY �—� B� 95.ya' /� P^q'��Yy�+e,- Lo'I�{^ /<< ��^a-� Ei3 9Y•33' '� . . `,` �oP� � R. o. W. FELSE(Z ► � � i � � I ' I , " I , � ,� ��- � - �: .-- �- � 9y�� I I � 9��, � 3`� � I � � K _ � � j�u�y oi;�. �' �j �J �n,a'��i 5 � L � I p (�(C L� RI I 0�i I N 9� . p,�� _ °��►� � � � I m ` ( � � z r� i � � � a.s��' � � I _� IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit} � - min. 12" TYPICAL TRENCH SOIL COVER «P�� CROSS SECTION VIEW 12" min. trench (No Scale) depth • (lYPical) a ' . .n' � � • •. • . ,d � a �—_ 34 . .a. .. , . (rypical) •;'a ^ � a e• � • (,� Provide minimum 3 ft • ' C� � — -I � �separation between trenches. System Elevation = � ft (typical) Quick4 Standard-W w/ End Gap Observation Pipe t ical) (Show location of inlet / outlet pipe connection on plan view.) (typical) TyPICAL TRENCH � YP Install per manufacturers — �tions. PLAN VIEW /— - -� — / (No Scale) 104 f �,� � r1 �� R�� , i�k��_ — _ _ �/� _ _ _ _ — _ �_ �/ �IrRr�'r��9;+��'�.�� ,a ��r�� /� p . O : � . � [f . �I H - 3.o It �' Q"� . �`: ', � w ; � �* ' + �tYPical) ;. � �Y°��`i� ff'��1��' '[.W"�ii�i�°� ,#.�"�' ��i; i''.1�.�`f�� It i�_:�"+�� — — — — — — — — — — �� — — — — — — — �� — — — — — — — — — B = �� ft -I �' {typical) Quick4 Standard-W Chamber (n INSTALL PER TRENCH: (typ�� W (mfd by Infiltrator Systems, Inc.) � Install pursuant to manufacturers instructions. O � Quick4 Std-W @ 20 f� EISAlchamber = �� ft2 �1 + � Pairs of end caps @ 6 ftZ EISA/pair = �, ft2 � = Proposed EISA per trench = � ' �' ftz Required Infiltration Area = � -5 ftz Distribution Method: x � trenches = Proposed Total EISA = � 3 � ftz (�i��`�Z�� ( � o � �� ,.,.� b c s I ; � �[ 6 �:�� _� �� S 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 pertormed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. Maximum Dispersai Area Operatina Limks: Design Flow= "I � � gpd; BODS<_220 mgL''; TSS 5150 mgL''; FOG 5 30 mgL'' Inspection Checkllst 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,eic.) o distribution lateral or Iateral 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-thlyd(1/3)the liquid volume of the tank(s)or as req�ired by tocal ordinance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code. o Effiuent fllterlsl shall be inspected every 3 years and shall be deaned when necessary to remove any accumulated solids according to manuFacturer's specifications. A servicing period will always be greater than 12 months. System malntenance reports shall be submitted to the proper local govemment unit in accordance with SPS 383.55 Wisc.Admin.Code. Report any component failure or malfunctfon to: Name of individual or company: DBCI BUCCII Phone: 715.416.1642 Local government unit: SaWYef COUnty Z011lflg Pnone: 715.634.8288 Local govemment unit address: 1061 O M8111 St. #49 ZiP: 54843 Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.57(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. SYstem Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. WLP 1000— M R TANK SPECIFICATIONS � o � 8, 8„ o a � DIMENSIONS: � o WALL: 2 1/2" � a 4" CAST-A-SEAL 4" CAST-A-SEAL BOTTOM: 3" COVER: 5" __ MANHOLE: 24" t.D. PRECAST CONCRETE RISER Q ��%' '��. HEIGHT: 53 1/4" � �%' �� LENGTH: 8'-8" ii� �� WIDTH: 7'-2" � %�%�_,\ Q��Q �/T� ��` BELOW INLET: 42" . LIQUID LEVEL: 36" � N � 1 l WEIGHT: 6,790 LBS. � o ` r � � _�� INLET AND OUTLET: -�� 3 � � \�� ` �� 4" CAST-A-SEAL BOOT OR EQUAL GASKET � m o � �� FILTER OR // o a �� BAFFLE �i� � � ,�; 3 INLET AND OUTLET BAFFLE AND FILTER: Q Q � w �`:�� ,,i'� WISCONS�N, SEE DETAIL #10 N o o � \�------- (OTMER STATES SEE CHART) �, o � n LIQUID CAPACITY: 27.83 GAL/IN W n TOP VIEW � � HOLDING TANK: OUTLET HOLE PLUGGED � � � ACTUAL CAPACITY: 1,085 GALLONS 0 � � w LOADING OESIGN: 8'-0" UNSATURATED SOIL � � �n � N o TANK CAN BE USED AS: � o � � � SEPTIC / HOLDING / PUMP OR SiPHON W , o a � a = � � COVER: MIX DESIGN #8 (NO FIBER) W � _ � _--- TANK: MIX DESIGN #10 (STRUCTURAL FIBER) � � ---- _� CUSTOMIZED TANKS: � 3 --- ' --- FOR CUSTOM TANKS CONTACT WIESER CONCRETE INLET - OUTLET N I � �Q � =-� � ''*�a r�'j _ U � � u� I r U . J � cv a _ I � d I m � Q � � d- � '� I � � "� � Z I � 1 2�� _--�- J � a ----- -�-�---�: o � REVIEWED BY � c� ;� PUMP PAD REVIEW DATE � W � DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL APPROVED BY: SHEET N0. APPROVAL DATE: � � OF TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: / � Soil Profile Sheet Owner._ �i��f Soil Tester. �S.-�r. i SystemElcvation: `e' ��'� Load Rate: 9 �O System Rang�:GI_3`/� q 3.33 I�o � _ � � 3 ........... ............ ............ � .:.......... ............ � ............ ............ ......... ............ i ...........: ............ Q� ........... ............ .....,..... _--...... � ............ ............ ............ a ............ ............ ........... ...-- .._... � ............ ............ Q� ..._....._ ............ ............ , ............ ..--- ----- _q S�,Yo2 .;,......:. i ..........:... ............ QS —`'1��c � .-,• ---- ............ ............ � .--..._... ............ o -7 Q.� ............ ............ � . �� ........... ,._._...... ...........;_qY.3 3 --� R / 1� . ........... ........... _`T3.6']� - 93.9a� ,� b� 2 / `�/ ... ... � •-• ... o� ... ... p .� ..... ............ _�i2.S� �- ........... � .......... ........... � ............ �.� � ............ �� ........... _�-- ........... ............ _ qi.a� � (� ............ 0 � ........... , ............ � .......:.... i ............, y�.�� ............-91,3y��''-- ............ RI ...........: . /JrP. � N.'�. ........... _9/•l6!�—, / ............ ' �J.D ............ � ..........,. � . � ......:..... � ' ........... 1 ........... ............ Qp ............ ............ � �3 _.......... -�3 i .... ... ... ... ... ... '�3� g� ............ . � ... ....--• � .....'...... � � ...... •- ......:..... _SS•3Y' � ............ _ $S.og' ............ , �$ ..... ...--• .........._ 88,i 6. ......... ............ i ............ ........... ............ .......... . ..... ...... � .......... ............ . � ..........,, ... � .... ...... 4/77/23, 11:03 AM Real Property Listing Page Real Estate Sawyer County Property Listing Property5tatus: Current Today's Date: 4/17/2023 Created On: 2/6/2007 7:55:20 AM �Description Updated: 12/15/2017 '� Ownership Updated: 3/17/2023 Tax ID: � 11647 �� LOREN G&LOURDES KILMER HAYWARD WI PIN: 57-010-2-41-OS-32-2 01-000-000160 Legacy PIN: 010841322116 Billing Address: Mailing Address: Map ID: .5.16 LOREN G&LOURDES KIIMER LOREN G&LOURDES KILMER Municipality: (O10)TOWN OF HAYWARD 10299N ROUND LAKE SCHOOL RD 10299N ROUND LAKE SCHOOI RD STR: 532 T41N R08W HAYWARD WI 59843 HAYWARD WI 54843 Description: PRT NENW LOT 3 CSM 25/87#6691 Recorded Acres: 1.020 � Site Address * indicates Private Road Calculated Acres: 1.024 � �� - Lottery Claims: 0 First Dollar: No lJ property Assessment Updated: 11/9/2015 Zoning: (RRl) Residential/Recreational One Z023 Assessment Detail ESN: Code Acres Land Imp. G1-RESIDENTIAL 1.020 19,000 0 � Tax Districts Updated: 2/6/2007 . .._.____—__... 1 � S[ate of Wisconsin 2-Year Comparison 2022 2023 Change 57 Sawyer County Land: 19,000 19,000 0.0% O10 Town of Hayward Smproved: 0 0 0.0% 572478 Hayward Community School District Total: 19,000 19,000 0.0°/o 001700 Technical College • Recorded Documents Updated: 3/17/2023 C�Property History WARRANTY DEED N�q � Date Recorded: 3/14/2023 443702 WARRANTY DEED Date Recorded: 6/13/2022 439639 WARRANTY DEED Date Remrded: 10/18/2004 325926 CERTIFIED SURVEY MAP Date Recorded: 11/13/2003 317181 https:l/tas.sawye�countygov.org//systemlframes.asp?uname=Eric+Wellauer �� r � r;:'e ' I . �' %°'�.. �'� t � : .- Y��Y �1 11.-'�„ li � �c m, �.,w?¢ .� � .,.�- �- '" 'f'..t" . r' � �.- �, '�` � -��a/Q4 . ��, ��_ �'�•-�-" '�Y� �91�;+' �%'��.',� . .'- : <� � . �. ti��a�� s ;s ��". f'�o 3 '�"' .�.y � µ'� _ � � �' I- -S. ��. ♦ � � ♦ - F-� � y � �9�' � ..�> �,�r 'i � `''�` �"y :�+`+C' I�« % �"` > � � `"+, .'.�" �Y� '�r �` � t � � �` ��.�� p� �:.�'�.�Y�'Sr, . +�' ,r �,eC..r, +�.Ac"`i''J"�_. ,yu i f La��/ „E ?_�- r. _ �� r f �� $"4 ��r�� r � ;v '�� +�' �j �� 1- ,h i�' � �� f f 4i�� !., K � � A',. d q't7� �,,,. � { J .r ,� -t � - D �� . �'.c ':.'.Y'�� h � �..� -'s�� r�. ..J + '�` ,f. � R . _S r.," q.,. � f . � � �` �f ��r � 1� � � ">s �k ^' f �A ,,.,ii `r'�'�, ��"``�y i'^ `"�"�-�� *.ti � � �. �: r.. � .� m -7'- a'^' �.� 4� "t�. t. � �� ~ � �' �,p�yy�' �s� ..-;��`i. ,�'� :� ..y}��V a ' �3' r ,S � ', 1 �,� �"� *~ +..z""��'�f.z�'r ".-A r � ' ..��^',�",�X:..� t ;� �.. ,Jn.. ..- �,,.1.> _� t�` � w TrF�.�' �..�s� Jf` t-aA� y��f.. �a� , t �� .�'4Y�1 f' � 1 iS _'_ Jt '. 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I - ' t � � ' ' �� '_r�� SEP 1 3 2023 D Office of Sawyer County Zoning and SAWYER COUNTY Conservation Administration ��G ADMItVISTR�ITION� • 10610 Main Street, Suite 49 Hayward, WI 54843 � TeL•(715)634-8288 Fax:(715)638-3277 URL:http:!isaw��ercount��ov.or� Email:zonin�.secnsawvercounty�ov.or� Toll Free:Courthouse/General lnformation 1-877-699-4110 Sawyer County Zoning and Sanitation "As - Built" Form Property Owner's Name L��2� l�i �m�� Fire Number and Road Name �� SL'/' �a L--h�#� Plumber's Name ��tC.�l� Date of lnstallation l�9�0�� County Sanitary Permit Number �� S ? 12 Digit Parcel Number � �U '�L� �— ��a"1� ` ` �^,, �/ !� Description and Elevation of Benchmark [ V 0 '- �7 �/�� Tank Manufacturer and Capacity �// �s�',� f(�� Setback-Tank to Nearest Lot Line ��jy- i � Setback-Tank to Nearest Well N�/�- Setback-Tank to Building /� � Cell Width 3 � � C �� Cell Length '� Number of Cells � Setback-Cell to Nearest Lot Line ,�//� --, Setback-Cell to Nearest Well /��4' Setback-Cell to Building �� Setback-Cell to Navigable Water � Make and Model of Dispersal Unit �vi�� / G�7 � Make and Model of Filter �(��L oek S �J -� �Make and Model of Pump i►v f} - Please complete other side- "As-Built Plot Plan" Elevation Data Benchmark a � Please include the followin�: Building Sewer �I, C Tank In S,� � Location of observation and vent pipes Tank Out �./S • Feet of risers used on tank(s) Dose Tank In � • Location of benchmark and North arrow Dose Tank Bottor� N//} _ • Location of all components Header or Manifoiu �,'�. � � Length of pipe between components Distribution Pipe • Number of chamber units in each cell System Elevation _�,� • Location of well, lot lines and road — --- ---� _____.__ _.______._..-- _— --_ r�lS�r � � � � �_.� � N�,wz 1l C� f 'S' p� r�Sztj �M. � -��j � r �; � ( � °�� i�e�✓f.� � � � � � '> • : � 13 � � � � � I3 C��;k ��f r (