HomeMy WebLinkAbout014-941-09-4301-SAN-2023-191 `�`�"'���:� Industry Services Division County
_` ��� 4822 Madison Yards Way SAWYER �
,�_' - Madison,WI 53705 Sanitary PertnitNumber(to be filled in by� �
= P.O.Box 7162
_ Madison,W I 53707-7162 � S� �� � �
State Transaction Number �
Sanitary Permit Application �
ln accordance with SPS 383.21(2),Wis.Adm.Code,submission of[his form to the appropriate govemmental unit �- ,.�
is required prior to obtaining a sanitary pertnit Note:Application forms for state-0wned POW'I'S are submitted to Project Address(if different than mailing a� —'
the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary I 1453N State Rd 2777
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#
Larson Family Property Trust
oiy - 9Yl - o�- K3� I
Property Owner's Mailing Address Property Location
4931 Bonita Bay Btvd #1802
City,StaYe Zip Code Phone Number y� �
Bonita Springs,FL 34134 `5 St
�%a�k'�'/,, Section 9
II.Type of Building(check all thAt apply) Lot# South Lot Yv T 41 N R 9 E o
�I or 2 Family Dwelling-Number ofBedrooms 2 Subdivision Name
❑Public/Commercial-Describe Use Block#t
❑City of
❑State Owned-Describe Use
CSM Number ❑Village of
/�Town of Lenroo[
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on iioe B.Complete line C if
a licable.
A� New S stem ❑ Re lacement S stem ❑Other Modification to Existin S stem ex lain ❑ Additional Pretreatment Unit ex lain
� Y P Y g Y � P ) � P )
B' ❑ Holding Tanlc �In-Ground ❑ At-Grade ❑ Mound ❑Individual Site Desigrt ype( p )
❑Other T ex lain
(conventional)
ist Previous Permit Number and Date Issued
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑ Transfer to New Owner ...�
Expiration
IV.DispersaUTreatment AreA And Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
300 .7 428.6 450.2 91.50
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units �, � o � ^
New Tanks Existing Tauks � � � " � p � �
0
a U v� y cn iz, C7 a.
Septic ot Holding Tank 50 50 1 ieset
Dosing Chamber
V.Responsibility Statement-I,t6e undersigoed,assume responsibility for inshllation of the POWTS s6own on the attached plins.
Plumber's Name(Print) Plumbe ' Signature � MP/MPRS Number Business Phone Number
Gerald Frcemel `i�/�''�� 950111 715-558-1138
.Z��
Plumber's Address(Street,City,State,Zip Code)
13502W Frcemel Rd Hayward,WI 54843
VI.County/Department Use Only
�A E� ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial S `�0• � ���� (`�-3 ���'I�-�-�'�-�
Conditions of Approval/Reasons for Disapproval �
D � L,`,U
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��� � � �F. r�N UG 14 2023
GI . A
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�S� oZ3- O�a Rc: �t��a �.._e_
SAWYER COUNTY
ZONING ADMiNISTRATION
Athch to rnmpletc plaes[or t6e system and sabmit to t6e Coanty only on paper aot leas than 8 t!1 a 11 iec6es in size ' -, J' �
0
SBD-6398(R 03/2l)
-�`�o��h ��T�
Larson Family Trust Property Owners Name
11453N State Hwy 27R7 Property Address
�Sou,ri,l�t.� Tax Parcel Number
Sawyer County
NW/SE �Gov Lot or Qtr-Qtr/Qtr
S9 Section
T41N Town
R9W Range
Page Index
1 Property InfoRnation
2 Data Entry
3 Plot Plan
4 Drainfield Cross-Section
5 Dose Tank
6 Maintenance Plan
7 Contingency Ptan
County Parcel Listing
Gerald Froemel Plumber's Name
� � Plumber's Signature
950111 Plumber's License Number
715-558-1138 Plumber's Phone Number
08/14/23 Date
Not an endorsement,written or implied for the toltowing companies and products;DelZotto Concrete,Wieser Concrete Products
Inc.,Skaw PreCast Co.,Huffcutt Concrete Inc.,Zabel Environmental Technology,ITT Industries(Goulds),The Pentair Pump
Group(Myers),►nfiltrator Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,Simlfech Fifter tnc.,Sta-Rite Industries,
Page 1 of 7
In-Ground Soil Absorption SBD-10705-P(N.01/01)Version 2�� �Component Manual Used
2 Number of Bedrooms V�
4 Percent Slope (%)
102 �T;Depth to Soil Limiting Factor (in.)
0.7 In Situ soil application rate
200 Estimated Wastewater Flow (gpd)
300 Design Wastewater Flow (gpd)
1 ;Number of System Elevations
91.5 � ;Proposed System Elevation#1
�^�Proposed System Elevation #2
��,Proposed System Elevation #3
�Original Grade#1
95 'Finished Grade#1
� ��Original Grade#2
°Finished Grade#2
��.Original Grade#3
���T Finished Grade#3
Infiltrator Quick 4 Standard Chamber Type
15 Height of Chamber(in.) 20 sq.ft. per chamber
2 iRows of Chambers 5.1 sq.ft. per pair of end caps
3 Distance Between Cells (ft.)
22 �Proposed Number of Chambers Used
428.6 Minimum Distribution Cell Area Required (sq.ft.)
450.2 Distribution Cell Area Proposed (sq.ft.)
Wieser 750 Septic Tank ose an �i�appiicabie): F�y� ____ _ _ _—__�
�
Lifetime �� � r Effluent Filter **select only if NOT using combo tank
Surface Depth to System
Soil Boring Grade Limiting Lowest Highest Elevation
Number Elevation (ft.) Factor(in.) Elevation Elevation Acceptable
1 95.79 108 89.79 94.54 TRUE
2 94.70 102 89.20 93.45 TRUE
3 94.84 108 88.84 93.59 TRUE
4 94.43 102 88.93 93.18 TRUE
5 �
Page 2 of 7
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Cross Section of a Two Cell In Ground Ccmponen;
Us+ng Leaching Chambers
Observation/Ve�it Pipes
� �
95.00 Finished Grade - j - -�- - - � Finished�rade—�
Siope / ( CeN"Seperation i�
-- __ i ,. �, 1..�_7' ',
/ `,. � �, A�
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Original Grad�- _/ �y� ''� � �`� -'� .�riginal Grade
�, „
92.75 Top of Chamber ____ _� _ /ti'���,�' / � � __ �'k�,.'Top of Chamber 92.75
, . •. ,,,
91.50 System Elevation �'�• . . .. � '�V System Elevation 91.50
�::���� . ,' .• i - . • '��:r��'
' •.• .T'reotrr,ent'pnd'Dispe-so1.Zor�e. �
� , ,. .�. . ` _• �• . . , •, •' .f• '
• --- - - •---- - � � ' • . _.�_ _ �. Limiting Factor
Obse�va: o�/Ven; pipes to be constucted and capped with opproved moteriols for the particuicr use.
Dia rams Not To Scale
-- —
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bservation/Vent Pipes to be located 1/5 to 1/10 the length of the distrution cell measured from the end of the cetls
Page 4 of 7
�
larson Famil Trust
11453N State H 27/77
Number of Bedrooms 2 Septic Tank Wieser 750
Estimated Flow(a�erage)gauons i day 200 Effluent Filter Lifetime
D8Si9n FIOw(peak),(Estimated x 7.5)gaVday 300 Pump Tank #N/A
Soil Application Rate gal/day/ft2 0.7 Pump Type
Influent/Effluent Qual' Monthl Average
Fats,Oil&Grease FOG 30 mglL
Biochemical O�cygen Demand(BODs> 220 mg/L
otal Suspended Solids(TSS) 150 mg/L
,.,.�����r_-,, Servicing frequency of 12 months or less requires lhe
Management Plan be recorded with the Register ot 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 slud e and scum=113 of tank volume
Inspect dispersal cell(s) At least once every 3 Year
Ciean effluent filter At least once every 3.Y_�ear „
Inspect pump,pump controls 8,alarm At least once every
Maintenance Instructions
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following
licenses 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,identrfy 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 surtace. 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 surtace. 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 1/3 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.
SWrt-Up and Oceration
For new construction,pnor to use of the POWTS check treatment tank(s)for the presence of
painting products or other chemicals that may impede the freatment process and/or damage the
dispersat 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 infittrative 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 pertormance and
prolong the life ot 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 ihe P01NTS 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 Administrative
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 identify a suitable replacement area. Upon failure of the POWTS a
soii and site evaluation shall be performed to locate a suitable repiacement 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 infinged upon by required setbacks from existing and proposed structures, lot lines and
wells. Failure to protect the replacements area will 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 and/or soil limitations. A holding tank may
be installed to replace the failed POWTS.
Septic, pump and other Veatment tanks may contain lethal gasses and/or insufficient ouygen. 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
Name Gerald Frcemei Name Scott Poppe
Phone# 715-558-1138 Phone# (715)634-1450 ��
POWTS Maintainer Local Regulatory Authority
Name Jays eptic Agency Sawyer County Zoning
Phone# 715-558-1138 �� Phone# 715-&34-8288
Page 7 of 7
Real Es[ate Sawyer Counry Properry Listing Property Status: Current
Today's Date: 8/14/2023 Created On: 2/6/2007 7:55:30 AM
�.. Descrip[ion Upda[ed: 2/17/2021 ... Ownership Updated: 5/10/2021
Tax ID: 17812 LARSON FAMILY BONITA
PIN: 57-014-2-41-09-09-4 03-000- PROPERTY TRUST SPRINGS FL
000010 KENNETH R & BARBARA J
Legacy PIN: 014941094301 LARSON
Map ID: 15.1
Municipality: (014) TOWN OF LENROOT Billing Address: Mailing Address:
STR: 509 T41 N R09W LARSON FAMILY LARSON FAMILY
Description: SWSE PROPERTY TRUST PROPERTY TRUST
Recorded Acres: 40.000 4931 BONITA BAY 4931 BONITA BAY
Lotrery Claims: 0 BOULEVARD BOULEVARD
First Dollar: Yes SUITE 1802 SUITE 1802
Waterbody: Little Round Lake BONiTA SPRINGS FL BONITA SPRINGS FL
34134 34134
Zoning: (F-1) Forestry One
ESN: 400 G� Site Address * indicates Private Road
v. Tax Districts Updated: 2/6/2007
7 State of Wisconsin �_praperty Assessment Updated: 5/17/2023
57 Sawyer Counry
014 Town of Lenroot z023 Assessment Detail
Hayward Community School Code Acres Land Imp.
572478 District �*1-RESIDENTIAL 1.000 9,000 8,200
001700 Technical College G6-PRODUCTIVE 39.000 94,300 0
FOREST
.: Recorded Documents Updated: 4/2/2013 z_Year Comparison 2022 2023 Change
.. WARRANTY DEED Land: 96,000 103,300 7.6%
DateRecorded: 4/1/2013 384259 Improved: 0 8,200 100.0%
.. QUIT CLAIM DEED Total: 96,000 111,500 16.1%
Date Recorded: 4/3/1987 384259 401/482
I.�Property History
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�"""`� PRIVATE ONSITE WAS�E TREATMENT county
�, � o$ ` SYSTEMS SaWyer
,�., `l��Ps '"� ( POWTS)
` k �_.:P i
"";` INSPECTION REPORT Sanitary Permit No:
Safety and euildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION -1 �_ 'Q 1
Personal information you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)] d� t �
Permit Holder's Name: ❑City ❑ Village �1 Town of: State Plan Transaction ID#:
�"��JN �IMv�;\ 1��-!( �'� L¢.hCb'D� �_'
Insp BM Elev: BM D cription: S� d Parcel Tax No:
loo.o ��s' w w. s:�, a� I `��dti� wf ���tid�, 7
TANK INFORM TION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w; Benchmark kjp,or
Dosing
Aeration Bidg. Sewer �t3•Y �
Holding St/Ht Inlet �2qs-�
TANK SETBACK INFORMATION St/Ht Outlet 9�,g '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic �-$ r/ �- N � NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 9;Z,7S
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative t
Surface ��'7S
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO TIO
DIMENSIONS �N 3� L �y �( #of Cells Type of System Distribution Media Manufacturer'
SETBACK OHWM of Nav � Conv ❑ Aggregate `��\�
P/L Bldg Well ❑ IGP � Chamber 'r"z�'
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO S �,/ � �� ❑ Mound � Other �
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-- -- -__— - --- — ----_- _ ---
DISTRIBUTION SYSTEM X Pressure Systems Only
( 9 g - p � X Hole Observation Pipes
Len�}hr/Manifoltl Dia _ _ L�enn hution Pipe(s) Dia S ac X Hole Size � Spacing ❑Yes ❑ No ��,
SOIL COVER
— -- - - — ----- -- _ --
Depth Over Depth Over Depth of Seeded I Sodded Mulched
Cell Center Cell Edges � Topsoil _ ❑Yes ❑ No l ❑Yes ❑ No �
COMMENTS: (Include code discrepa�cies, persons present,etc.)
��w���.di ��s(��
Plan revision required?�Yes ❑ No ��3 , ��- � � . � �I' 6c.����
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3l01)
ADOITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBEA _______2�=���________.
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