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Home My WebLink About002-940-01-5303-SAN-2023-049 C_/� i'�' ' Industry Services Division County - � " �' 4822 Madison Yards Way Sawyer � = .�=r - (�� Madison,WI 53705 Sanitary Permit Number(to be filled in by( = a 3 P.O.Box 7162 � - G1�f Madison,WI 53707-7162 � �<� �j (p� _ � Sanitary Permit Application State Transaction Number . � In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit � .� is requiced prior to obtaining a sanitary pertnit Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing a� '� the Departrnent of Safety and Professional Services.Personai information you provide may be used for secondary �� _ purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. �� 1 ' I.Application Informatioo-Please Print All Information a '►'i`^�y � �;td Property Owner's Name p��# Barbara Krzak 00294001539t / 'L�✓ �� p C o.••i7 Property Owner's Mailing Address Property Location 9399 N Cty Hwy E Govt.Lot City,State Zip Code Phone Number Hayward,Wl 54843 1•IE�/,, SW'/., Section 01 _ II.Type of Building(c6eck all thxt apply) Lot# T 40 N R 9W E or W � �1 or 2 Family Dwelling-Number ofBedrooms 3 Subdivision Name Block# ❑Public/Commercial-Describe Use ❑Ciry of �State Owned-Describe Use CSM Number ❑ViUage of �Town of Bass Lake III.Type of POWTS Permit:(C6eck either"New"or"ReplacemenY'and other applicable on line A. Check oee box on line B.Complete line C i a licable. `�' New S stem � y ❑ Replacement System ❑Other Modificaiion to Existing System(explain) ❑ Additional Pretreatrnent Unit(explain) B' ❑ Holdin Tank -Ground ❑At-Grade ❑Other T �x lain g �.in ❑ Mound ❑ Individual Site Design ype(., p ) (conventional) C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration l IV.DispersaUTreatment Area and Tank Information: Desigr►Flow(gpd) Design Soil Applicafion Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevafion 450 .5 900 915.3 92 Capaciry in Total #of Manufacturer Tank Infortnation Gallons Gallons Units ` o '� � New Tanks Exisliug Tanks � � y � Y � � � 0 a, U cn �, �n w � 0. Septic or Holding Tank 1000 1000 1 ieser Dosing Chamber V.Responsibility Statement- I,the andersigoed,assume responsibility for iostallation of the POW1'S shown on t6e attached plans. Plumber's Name(Print) Plumber's Signatu MP/MPRS Number Business Phone Number Gerald Frcemel 9501 I 1 7I5-558-1138 Plumber's Address(Street,City,State,Zip Code) 13502W Frcemel Rd Hayward,WI 54843 VI.Cou ty epartment Use Only �Ap ve ❑Disapproved Permit Fee Date Issued Issuing Agent SignatwE $ ,/�� / ❑Owner Given Reason for Denial �00.� ��'� 3 �'/w�tt�C'��Z-�/1�2'--� Conditions of Approval/Reasons for Disapproval D � ^ � D �� ' ��`� ��o� �3 G � D te _m_ _r�.. L a 23 MAY 0 8 20 C s -� Chk# � � 3� � gqWyER COUNTY T �� - v:� 3 _, :u ��.�c� ; ZANNdCi N)MlN1STRATtON � �.�..F. :. �'._ ..,..,._...a_.. __� -._._._._,.... _ Attac�io complete p�ana for the syatem aAd submit to the Coaoiy only oa paper oot lesa t�aa 8�n z 11 ioches io size `'AY�C✓1��• :�-ZO�l � SBD-6398 R.03/21 NO RcFUNDS AFTER ` � � ISSUE OF PERMIT ��`L�• `�`��S � �N� Barbara Krzak Property Owne�s Name TBD next to 9399N Cty Hwy E Property Address 2940015301 Tax Parcel Number Sawyer County � NE/SW Gov Lot or Qtr-Qtr/Qtr S 1 Section T40N Town R9W Range Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross-Section 5 Dose Tank 6 Maintenance Plan 7 Contingency Pl�n County Parcel Listing Gerald Froemel Plumber's Name l Plumber's Signature 950111 Plumber's License Number 715-558-1138 Plumber's Phone Number 05/08/23 Date Not an endorsement,written or implied for the following companies and products;DelZotto Concrete,Wieser Concrete Products Inc.,Skaw PreCast Co.,Huffcutt Concrete Inc.,Zatrel Environmental Technology,ITT Industries(Goulds),The Pentair Pump Group(Myers),Infittrator Systems,ADS Produds,Polylok Inc.,Orenco Systems Inc.,SimlTech Filter Inc.,Sta-Rite Industries, Page 1 of 7 q aa -�� In-GrourM Sail Absorplion SBD-1070SP(N.07/Ot)Version 2,I Component Manual Used 3 Number of Bedrooms 1 Percent Slope(%) 102 IDepth to Soil Limiting Factor(in.) 0.5 iln Situ soil application rate 300 Estimated Wastewater Flow(gpd) 450 Design Wastewater Flow(gpd) 1 Number of System Elevations 92 Proposed System Elevation#1 Proposed System Elevation#2 Proposed System Elevation#3 Original Grade#1 96 Finished Grade#1 �Original Grade#2 Finished Grade#2 ,Original Grade#3 ;Finished Grade#3 Infiltrator Quick 4 Standard Chamber Type 15 lieight of Chamber(in.) 20 sq.ft.per chamber 3 Rows of Chambers 5.1 sq.ft.per pair of end caps 3 Distance Between Celis(ft.) 45 Proposed Number of Chambers Used 900.0 Minimum Distribution Cell Area Required(sq.ft.) 915.3 Distribution Cell Area Proposed(sq.ft.) Wieser 1000LP Septic Tank ose an (if applicable) Lifetime �" '� EfFluent Filter "select onty rf NOT using combo tank Surface Depth to System Soil Boring Grade Limiting Lowest Highest Elevation Number Elevation(ft.) Factor(in.) Elevation Elevation Acceptable 1 96.10 114 89.60 94.85 TRUE 2 95.10 102 89.60 93.85 TRUE 3 94.36 96 89.36 93.11 TRUE 4 __._ 5 Page 2 of 7 � 1� � �9�'�;�� G%�'�� --��5 � j ° w � � -�� ,�o�� o� �o � � s ��o� ��° �;S � 2 • Q��z-r i� l �,S�zb -- S,ob a N-�a 7 � a o r_ I ,�,�,�j, n 2b ')2 ..1"5 �S�;d5 S aotla� P ��i'fib � , F—'1'�b , ��$b 2 � 1'D�b 1�C ° �'f"O .r�� a�P;5 i �,r�o�y d�,e-� �^°9q:� �� I �9 �C \ lo�a �� 1ro� � � �� s � ' oJ � �°"' \ `r � c�� F � i� ,, ,r� �a�s , x � -�� o� o o. yo. � 7 l O� �� ,�� a�� 5�� s / d1 L2 L # b22��- 1.� 5'� , ��°'J cv 13af 2� ' a�.`S £ �7 : ,a n o '1 ��3 N �1�&h5 )cn 'P�,-nc-n l�»�.-) ,.}- '�-�' S `l� I UFS I �Q#�b2oQ N�� „ ��.I,n+}3 ' m� C'i bb£6 �c,-,� a-��°", SS'�� /.o.J ..,.a�r+�b5 yro2..t�» •,S '+7.svqab� ; 1—?�� 'I : .�BtiAM� J Cro�s Sacbon of a'i'hree Cell Ingioimd Component Using L.eaching Chnwbeis Fimshed Grade Original Grade 7y�� Top of Chamber 93.25 / �System Elevation 92.00 Pinished Grade 96 Slope 1% C .� eparaan —_ .FinishedGrade 96.50 � �3 Feet " � ,! �\ Original Grade ��,�j ��; �;� �� , 93.25 Top of Chamber �,� `�. Y� � �� ✓�Original Grade�—� ...... ....... . . ✓. : . ' � ( Y . : 1 j'�. . '�'� Top of Chamber 96e96�T.2s ... . ....�.'.... 92.00 SystemElevation . 'i �r%_.,.p_ r ` � �•�• . r SystemElevation 92.00 � �'�a�m�lbd�err77ph ' .•.. -� �: � � i : i :.: i� � ' � Ob�vYfm�Vmt pips b 6e am�cbJ�od c�pped w�116�ppovad m�Isi�h La me p�utdr us. Dia rams Not To Scale �� `o 0 0� .o o c. �• � „ , , , _ _ _ � � o o ; o o c�� , _ -, � ��I - . �—, .�i,��.�::`''L.i'�°t-L�l�` _ °��-.��t: � bservation I Vent Pipes to be located il5 to 1/10 the length of the distrution cell measured from the end of the cells Barbara Krzak BD neM to 9399N C H E 2.94E+09 Number o Bedrooms 3 Septic Tank Wieser 1000LP Estimated Flow(average)ganons i day 300 Effluent Filter Lifetime DESl9f1 FIOW(peak),(Estimated x 7.5)gaUday 450 Pump Tank #N/A Soil Application Rate gal/day/ftz 0.5 Pump Type Influent/Effluent Qual' Monthl Average Fats, Oil 8 Grease(FOG) 30 mg/L Biochemical Oxygen Demand (BODS� 220 mg/L otal Suspended Solids (TSS) 150 mg/L :!VGTci! Servicing frequency of 12 months or less requires the � Management Plan be recorded wi[h the Register of Deeds. Maintenance Schedule Service Event Service Frequency Inspect condition of tank(s) At least once every 3 Year Pump out contents of tank(s) When combined siud e and scum = 1/3 of tank volume Inspect dispersal cell(s) At least once every 3 Year Clean effluent fiiter At least once every 3 Year Inspect pump, pump controls&alarm At least once every Maintenance Instructions Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following lice�ses or certifications:Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, Septage Servicing Operator. Tank inspection must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals 1l3 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. A service report shall be provided to the County Zoning Department within 30 days of any service event. Start-Up and Operation For new construction, prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank removed by a licensed Septage Service Operator. System start-up shall not occur when soil conditions are frozen at the infiltrative surface. Page 6 of 7 Do not drive or park vehicles over tanks and dispersal cells. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fat, foundation drain (sump pump)water, gasoline, grease, oil, painting products, pesticides, sanitary napkins, tampons, and water softener brine. Abandonment When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with Wisconsin AdminisUative Code SPS 383.33; -All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. -The contents of all tanks and pits shall be removed and properly disposed of by a SepTage Servicing Operator. -After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. Continqencv Plan If the POWTS fails and cannot be repaired the following measurers have been, or must be taken to provide a code compliant replacement system: (Check One) '" The site has not been evaluated to identity a suitable repiacement area. Upon failure of the POWTS a soil and site evaluation shall be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed to replace the failed POWTS. ' A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structures, lot lines and wells. Failure to protect the replacements area wili result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not available due to setback andlor soil limitations. A holding tank may be installed to replace the failed POWTS. ��WARNING!! Septic, pump and other treatment tanks may contain lethal gasses and/or insufficient oxygen. Do not enter a septic, pump or other treatment tank under any circumstances. Death may result. Rescue of a person from the interior of a tank may be difficult or impossible. POWTS Installer Septic Pumper ame erald Froemel Name cott Poppe Phone# 715-558-1138 Phone# j(715)634-1450 POWTS Maintainer Local Regulatory Authority Name Jays Septic Agency Sawyer ounty Zoning Phone# 715-558-1138 � � � Phone# 715-634-8288 Page 7 of 7 Redl EStdt2 Sawyer County Property Listing PropertyStatus: Current Today's Date:3/1/2024 Created On:7/IS/2023 1:31:37 PM �Description Updated:7/18/2023 '�Ownership Updated:7/18/2023 TaxID: 44758 BARBARAJKRZAK HAYWARD WI PIN: 57-002-2-40-09-01-5 OS-003-000030 Legacy PIN: 002940015303 Billing Address: Mailing Address: Map ID: BARBARA J KR2AK BARBARA J KR2AK Municipality: (002)TOWN OF BASS LAKE 9399N COUNN HWY E 9399N COUNTY HWY E STR: 501 T40N R09W HAYWARD WI 54843 HAYWARD WI 54843 _ Description; GOVi LOT 3&PRT NESW LOT 1 CSM m 38/145#8712 r Site Address *indicates Private Road Recorded Acres: 24.710 9399N COUNTY HVJY E HAYWARD 54843 Calculated Acres: 0.000 Lottery Claims: 0 �•..-)proper[y Assessment Updated:N/A First Dollar: No Waterbody: Spring Lake Z024 Assessment Detail Zoning: (F-1)Forestry One Code Acres Land Imp. (RRl)Residential/Re�reational One N�A ESN: 406 2-Year Comparison 2023 2024 Change Land: 0 0 0.0% Tax Districts . _ Updated:7/18/2023 Improved: 0 0 0.0% 1 State of Wisconsin Total: 0 0 0.0% 57 Sawyer County 002 Town of Bass Lake 572478 Hayward Communiry S�hool Distric[ � O01100 Technical College �Property History Parent Properties Tax ID • Recorded Documents Updated:7/18/20Z3 57-002-Z-40-09-01-5 OS-003-000010 2693 CERTIfIED SURVEY MAP Date Recorded:7/7/2023 445292 QUIT CLAIM DEED Date Recorded:8/25/2014 391926 QUIT CLAIM DEED Date Remrded:2/24/2014 389456 WARRANTY DEED Date Remrded:8/18/2006 340984 CERTIFIED SURVEY MAP Date Recorded:7/24/2006 340412 Child.HistorY-Recor�_CouoL•_L—._--- --.... ------- — _ .—--- - ---- � -----�----..-- HISTORY O Expand All History White=Current Parcels Pmk=Retired Parcels O Tax ID:Z6 Pin:57- 02-2-40-09-01-5 OS-003-000010 Leg.Pin:002940015301 Map ID::3.1 44758 This Parcel Parentr Children � '-`"E'^� PRIVATE ONSITE WASTE TREATMENT county �,, �-=r �','��a$ ��'�� SYSTEMS SaWyer ��$ , ' ( POWTS) \�UF�.'.--- �e. �"-'"��='' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION ��j�—DY� Personal infonnation you provide may be used for secondary putposes[Privacy Law,s. 15.04(1)(m ] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: ��'� l�� 6�� (.�k� � Insp BM Elev: BM Description: Parcei Tax No: ,��3 03 �,�.D ' rW�t♦-r,�0ev� �{��i �� !" ,5�� ! 4�a�� C7,� .. [ l 0�� ( TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic ,,�^,�f- �,� Benchmark c�0.o' Dosing Aeration Bldg. Sewer 4S;o' Holding St/Ht Inlet �Y�S ` TANK SETBACK INFORMATION St/Ht 0utlet QY,�. ' TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet AIR INTAKE Septic -f-�` /V �/ NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. �,p � Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative , Surface Q�•o Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist. To Weli DISPERSAL CELL INFORMATION DIMENSIONS W 3� � o` ` bb' #of Celis ?j Type of System Distribution Media ManufaCturer: SETBACK OHWM of Nav 1� Conv ❑ Aggregate � INFORMATION P/L Bldg Well Waters °� GP l� Chamber Model Number: ❑ EZFIow ' ❑ Mound o Other CELL TO -f'S� _ N _ _ N -�oo_ — — DISTRIBUTION SYSTEM X Pressure Systems Only _ Yfi Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes � � Length Dia l Length Dia Spac � Spacing ❑Yes ❑ No J - — - - � — -�---- SOIL COVER � Depth Over Depth Over i D pte h of Seeded/Sodded Mulched Celi Center �ell Edges i Topsoil _ � ❑Yes ❑ No ❑Yes ❑ �.o COMMENTS: (Include code discrepancies, persons present, etc.) ��t�l� ��l �� ►�'e-V'' �Sr�' �2 �`s�) Plan revision required?�Yes ❑ No �U � �Zc� �Y � � /�� _ � �j�' � 1� � �v �J Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL C�MMENTS ANO SKETCH � �� , � SANITARY PERMIT NUMBEA __ �.3._C)`(�___ �° � `�� '' Kwr � � �r�` � � slo�.� � � � �P`�? � �, � � ( � �- � � \ 3 Q��'� /' �Ne� � � < �a�o�� / �' � /�,�r� \ � y�� N��`�,, �, � � Plb � �P_/ �'�� „' ,n�o. �� L- �,,,;� �' �1(�l�'1, �'�'(� �+� 1 C�• ,�(� , • �3�QY a I' � 3qq� !. '` nr�_ �� I �/� �OD � w � 6 � ��_