HomeMy WebLinkAbout014-281-00-0600-SAN-2023-192 _��� Industry Services Division County �
- 4822 Madison Yards Way SAWYER �
_ .��_' - Madison,WI 53705 Sanitary PemutNumber(to be filled in b� �
_ . P.O.Box 7162
_ Madison,WI 53707-7162 (y S f �Gj 3 Fj
— W
Sanitary Permit Application StateTransactionNumber �
In accordance with SPS 38321(2),Wis.Adm.Code,submission offfiis form to the appropriate govemmental unit �
is required prior to obtaining a sanitary pertnit Note:Application forms for state-0w�d POWTS are submitted to Project Address(if different than mailing
ffie Departrnent of Safery and Professional Services.Personai 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),StaYs.
I.Application Information-Plexse Priet All Information
Property Owner's Name Parcel#
Larson Family Property Trust ��y -9 y l - V9-y�QT.
Property Owner's Mailing Address Property Location
4931 Bonita Bay Bivd #1802
Govt.Lot
City,State Zip Code Phone Number
Bonita Springs,FL 34134 � %.,SE '/,, Section 9
II.Type of BuiMing(check all t6at apply) Lot# North Lot T 41 N R 9 E
l�I or 2 Family Dwelling-Number ofBedrooms 2 Subdivision Name
❑Pubtic/Commercial-Describe Use Block#
❑City of
❑State Owned-Describe Use
CSM Number ❑Village of
l�Town of Lenroot
III.Type of POWTS Permit:(Check either"New"or"ReplacemenP'and other applicable on line A. C6eck one box on line B.Complete line C if
a licab{e.
`�� �,New System ❑ Replacement System g y ( p ) ( p )
❑ Other Modification to Existin S stem ex lain ❑ Additional Pretreatrnent Unit ex lain
B' ❑Holding Tank �In�3round ❑At-Grade ❑Mound ❑ Individual Site Design ❑Other Type(explain)
(conventionai)
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner 'st Previous Permit Number az►d Date[ssued
Expiraiion
IV.DispersaUTreatment Area and Tank Information:
Design F►ow(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 Manufac.Kurer
::
Tank Information Gatlons Gallons Units � � v � N v
New Tanks Existing Tanks � c e� " Y D � �
a` U va � r� u. �.7 a,
Septic or Holding Tank 750 50 1 ieser
Dosing Chaa�ber
V.Res�►onsibility Statement- I,t�e uodersigoed,assume responsibility for iostsllatioo of the POWTS showo 0o the attac6ed plans.
Plumber's Name(Print) Plumber's Sign e MP/MPRS Number Business Phone Number
Gerald Frcemel ��s'`" ��� 9501 I l 715-558-1138
� "_ �
Plumber's Address(Street,City,State,Zip Code)
13502W Froemei Rd Hayward,Wi 54843
VI.Co n /Department Use Only
( Permit Fee Date sued, Issuing Agent Signature
�Appr v� ❑Disapproved �'�� ����
O Owner Given Reason for Denial s l�� � �3 � !
Conditions of Ap�p,r�oval/Reasons for�Disapproval �� � � ��
� ��-� �� �-`� 3 p
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' AUG 14 2023
{:_ �(�'�:�_.___.._...�._-. _
CsT �--3 - ba-� SAWYER COUNTY
20NtNG ADMINISTRATION
Attach to compkte plans for tYe system and sabmit to the Coanry only on paper Aot less thaa 8 t2:11 ioc6es m size L�r,� I C
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SBD-6398(R 03/21)
;� l�r�� �i�
Larson Family Trust Property Owners Name
11453N State Hwy 27R7 Property Address
ak c�Tf�(� Tax Parcel Number
Sawyer County
NW/SE Gov Lot or Qtr-Qtr/Qtr
S9 Section
T41 N Town
R9W Range
Page Index
1 Property tnformation
2 Data Entry
3 Plot Plan
4 Drainfield Cross-Section
5 Dose Tank
6 Maintenance Plan
7 Contingency Plan
County Parcel Listing
Gerald Froemel Plumber's Name
Plumber's Signature
950 11 Plumber's License Number
715-558-1138 Plumber's Phone Number
08/14/23 �� �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.,Zabel Environmental Technology,ITT Industries(Goulds),The Pentair Pump
Group(Myers), Infiltrator Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,Simlfech Fifter Inc.,Sta-Rite Industries,
Page 1 of 7
In-Ground Soil Absorption SBD-10705-P(N.01/01)Version 2�1 Component Manual Used
2 Number of Bedrooms
Percent Slope (%)
102 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
Finished Grade#3
Infiltrator Quick 4 Standard Chamber Type
15 Height of Chamber(in.) 20 sq.ft. per chamber
2 �Rows 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 (if applicable)$ �� ;
_ - ...._..�_____,._..�.....�.,�.__�__
Lifetime ;Effluent Filter "`select only if NOT using combo tank
Soil Boring Surface Depth to Lowest Highest System
Number Grade Limiting Elevation Elevation Elevation
Elevation (ft.) Factor(in.) 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 Ceif In Ground Ccmponen:
Using Lea�hing Chambers
Observatio^/Ve�if Pipes
� �
95.00 Finished Grade -- _ �.---— � Finished�rade—��
Slope � Cell�Seperation %
'-- � `, L�.<1' ,,
, , :y, �, ,- �,, "1
j '�' J i X �� i
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Original Grad�- -i' � �,��`,, �� f �`.Y;'�, ,�riginal Grade
>Y
92.75 Top of Chamber ti'� �� i __ .'_��_ �Top of Chamber 92.75
---- -f�'- j�� . , C9'-
, , .. ,,,
91.50 System Elevation '+• . . .: � '�V System Elevation 91.50
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� - .Treot�;en;�pnd'Dtspe-sa+.Zor�e. �
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• -.: - - ----- -._' . • , . . . .__ _ _ '. Limiting Foctor
Observat o�/Ven; pipes to be constucted and capped with approved moterials for the porticular use.
Di 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 cells
Page 4 of 7
Larson Famil Trust
11453N State H 27l77
Number of Bedrooms 2 Septic Tank Wieser 750
Estimated Flow(average)ga��ons�day 200 EfFluent Filter Lifetlme
DeSi9n FIOW(peak),(Estimated x 1.5)gal/day 300 Pump Tank #N/A
Soil Application Rate gal/day/ftZ 0.7 Pump Type
Influent/Effluent Qual' Monthl Average
Fats,Oil 8 Grease FOG 30 mg/L
Biochemicai Oxygen Demand(BODS) 220 mg/L
ofal Suspended Solids(TSS) 150 mg/L
„r<<�,-y,, Servicing frequency of 12 morrths or less requires the
MaintenanCe Schedule Management Plan be rewrded with the Register of Deeds.
Service Event Service Frequency
Inspect condition of tank(s) At least once every : 3 Year
Pum out contents of tank(s When combined slud e and scum=t/3 of tank volume
Inspect dispersai cell(s) At least once every 3 Year
Clean effluent filter At least once every 3 Year
Inspect pump,pump controls&alartn 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,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-Uo 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
iicensed Septage Service Operator.
System start-up shall not occur when soil conddions are frozen at the infitVative 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 foliowing steps shall be taken to
insure that the system is properly and safely abandoned in compliance with Wisconsin Administrative
Code SPS 383.33;
-AII 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 properiy 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 materiai.
Continstencv Plan
If the POWTS fails and cannot be repaired the foilowing measurers have been, or must be taken to
provide a code compliant replacement system: (Check One)
"' The site has not been evaluated to identiry a suitable replacement 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
soii 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 sVuctures, 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.
��YViiitNlNi;"
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 resutt. Rescue of a
person from the interior of a tank may be di�cult or impossible.
POWTS Installer Septic Pumper
Name erald Frcemel Name Scott Poppe
Phone# 715-558-1138 Phone# (715)634-1450 y ��
POWTS Maintainer Local Regulatory Authority
Name iJays Septic Agency Sawyer County Zoning
Phone# :715-558-1138 ��� Phone# 715-634-8288
Page 7 of 7
Real Estate Sawyer County Property Listing Property Status: Current
Today's Date: 8/14/2023 Created On: 12/20/2022 8:12:22 AM
�. Description Updated: 12/20/2022 �,.., Ownership Updated: 12/20/2022
__
Tax ID: 44618 LARSON FAMILY BONITA SPRINGS
PIN: 57-014-2-41-09-09-4 02-000- PROPERTY TRUST FL
000050 KENNETH R & BARBARA
Legacy PIN: 014941094205 J LARSON
Map ID:
Municipality: (014) TOWN OF LENROOT Billing Address: Mailing Address:
STR: S09 T41N R09W LARSON FAMILY LARSON FAMILY
Description: PRT NWSE LOT 4 CSM 38/68 PROPERTY TRUST PROPERTY TRUST
#8681 4931 BONITA BAY 4931 BONITA BAY
Recorded Acres: 15.910 BOULEVARD BOULEVARD
Lottery Claims: 0 SUITE 1802 SUITE 1802
First Dollar: Yes BONITA SPRTNGS FL BONITA SPRINGS FL
341.34 34134
Waterbody: Little Round Lake
Zoning: (F-1) Forestry One t,
ESN: 400 �►� Site Address * indicates Private Road
N/A
i.� Tax Districts Updated: 12/20/2022 , ,
1 State of Wisconsin �""" Property Assessment Updated: 5/17/2023
57 Sawyer County z023 Assessment Detail
014 Town of Lenroot Code Acres Land Imp.
Hayward Community School G1-RESiDENTIAL 2.000 i1 ,500 68,400
572478 G5-
District 3.630 400 0
001700 Technical College UNDEVELOPED
G6-PRODUCTIVE 10.280 46,300 0
FOREST
1�,: Recorded Documents Updated: 12/20/2022
_ _ __
L.,� AFFIDAVIT OF CORR CSM 2-Year Comparison 2022 2023 Change
Date 442757 Land: 0 58,200 100.0%
Recorded: l2/20/2022 Improved: 0 68,400 100.0%
1.►� CERTIFIED SURVEY MAP Total: 0 126,600 100.0%
Date 442681
Recorded: 12/14/2022
__ _-------�� �,\
..; DECLARATION OF EASEMENT �..: Property History �
_ __
Date 442662 Parent Properties Tax ID
Recorded: 12/13/2022 - 57-014-Z-41-09-09-4 02-000-
i..; WARRANTY DEED
000010 178ll
Date Recorded: 4/1/2013 384259
�� Q �t,, �� g� � �.( c�,` 1 ( � �
t, UIT CLAIM DE D � � G ��
�
Date Recorded: 4/3/198 204127 .
_ � �'���_ � ��.� y ��
HISTORY �+.� Expand All �i�to►y_ White=Current Parcels Pink=Retired Parcels �
�., Tax ID: 178ll Pin: 57-01.4-2-4 -09-4 02-000-000010 Leg. Pin: 01494] 094201 Map ID: .14.1
44618 This Parcel Jr� P �nts ��; Children
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"'"E`� PRIVATE ONSITE WASTE TREATMENT county
-����`o$� SYSTEMS
,r,.,,� PS ,�
( POWTS) SaWyer
H �— ��
°' '"� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION z 3—l� �
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(�n)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�O"�, �1�.� \ A. � � �py��b� �--�
Insp BM Elev: BM Description: Parcel Tax No:
��� 'c�� izls���, 1/�/.�,� J�(��4V` �''� `�`� � ���a"� �
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �„'L�' '7� Benchmark �po,p'
Dosing
Aeration Bldg. Sewer --�
Holding St/Ht Inlet ��(,`j�
TANK SETBACK INFORMATION St I Ht Outlet �Y,� �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic ,� ' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 9 Y�o�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative �3,��
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 � Yy #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav 6� Conv ❑ Aggregate ���
INFORMATION P/L Bldg Well Waters °� GP � Chamber Model Number:
❑ EZFIow
` � ❑ Mound o Other
- CELL TO _ � � ��___ __ _. __— __ ___ _ _—__ �f�-----
---- - - — -
DISTRIBUTION SYSTEM X Pressure Systems Only
9- — g pO — — P-- — ' X Hole Size X Hole Observation Pipas
CLen�hr/Marnfold Dia � L�enrth tion Pi e s Dia S ac �' ! Spacing ❑Yes ❑ No
_--- _ —_
---- — —
SOIL COVER
-- . __- - - - — --- — -
De th Over Lle th Over I De th of Seeded/Sodded Mulched
Cell Center � Cel�l Edges Topsoil __ ___� ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��,5��c� ��sl� 3
Plan revision required?�Yes ❑ No I0���c/ � ,� , �� � ��( �� � �
��—.._��.._�I '
Use other side for additional information Date OWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
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