HomeMy WebLinkAbout002-940-21-1104-SAN-2023-248 ��`� "'�' Industry Services Division Ca�tY �
•"`_�, _ 4822 Madison Yards Way ,5c�w y c`�' �
_ �.. _' - Madison,WI 53705 Sanitary Pemut umber(to be filled in by� Z
= P.O.Box 7302
Madison,WI 5302 �S � (p�-( C`i �
�J
State Transaction Number �
Sanita.ry Permit Application �
[n accordance with SPS 383.21(2),Wis.Adm.Code,submission offfiis fortn to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ad....,���
the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. I 5.04(1)(m),Stats. 5��e
I.Application Information-Please Print All Information
Prop,erty Owner's Name Pazcel#
1`0 6���T �9���K do;�-q�o �- �� - I�
cy
Property Owner's Mailing Address Property Location
I S�"�I +-✓ c✓o /�' L�l �� 4 i
City,State Zip Code Phone Number r ))
1�.Q �.✓�cl t�� W� ,. /�r"� 3 /V 1� i/a, �L� �/�, SCCtlO[l�—
II.Ty,pe of Buildiog(check sll that apply) Lot# T yV N R E o�
�,i or 2 Family Dwelling-Number ofBedrooms� 3 Subdivision Name
Block#
❑PublidCommercial-Describe Use
� ❑City of
❑State Owned-Describe Use CSM Number ❑Village of
��(<<d ��aY3 �To,�of__f�u Ss /�kF
III.Type of POWTS Permit:(C6eck either"New"or"ReplacemenY'and other applicable on line A. Check one box oe line B.Complete line C i
a licable.
`�� ❑ New S stem �Re lacement S stem ( Xp �
y p y ❑ Other Modification to Existing System(explain) ❑Additional Pretreatrnent Unit e lain
B' ❑ Holdin Tank In-Ground ❑ At-Grade
g � ❑ Mound ❑ Individua!SRe Design ❑Other Type(explain)
(conventional)
C- ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner �st Previous Pemvt Number and Date Issued
Expiration d S= 3 7� �0( 1 p l �
IV.DispersaUTreatment Area And Tank Information: �,^ ,�"r
Design Flo Design Soil Application Rate(gpd/s� Dispersal Area Re uired(s DisQersal Area Proposed(s� System Elevation
CJ �4C/ . lj c'HS► � `O�eliv /'�D� .l �y �� r
r
Capacity in Total #of Manufacturer
�
Tank Infomiation Gallons Gallons Units � o '� �
New Tanks Existing Tauks � _ � " Y � � �
a` U �n � v� i�. C7 a.
Septic or Holding Tank �—U �� �3�f
Dosing Chamber
V.Responsibility Statement- 1,the asdersigned,assume responsibility for installadon of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Sign �- MP/MPRS Number Business Phone Number
�"�r�,i�( �. F.�-�.,.��� �/.� l���«--� �s`�'/�l 7�s-s s�il 3�
Plumber's Address(Street,/C1ity,State,Zip Code)
/?S�a� �.�1/ /�iJE��'�'1 d � /�d' ��' /✓vt:�� L✓/� S�/J��
VI.C un /Department Use Only
❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�Q Owner Given Reason for Denial $ (w�� <� �`.J`� I`�3 �.G���'E'�f-�-e/t.�-
Conditions of ApprovaUReasons for Disapproval
� : o �C��s�a���f<<��
��� � �� .�_.____ __ s
�����`� , a9 �3 �1�;��
� �ate
SEP 2 9 2023 �-
GST O�—._30� ��nk# � �3 � . __ _ ____ . ,
��(`I SAWYER CCu`.s`-`;.
�4NlNG AGMi'!�t`�'i R�':TlC;';�
Atbcb to complete plam for the system and sebmit to the County only on paper not less than 8 tn:i l inc�es in size -�4�N
NO R�FUNDS A�TER
SBD-6398(R 02/22) 18SUE Of=F'�FIAIt1T
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 2022-2027)
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
OwnerName(s): �eb��T 1Voaak Phone:
Owner Address: �5���W i,;'�jF L/1/ l�"Y'""'`���-''r ZiP; 54848
Project Address: 5��--�
Govt.Lot:� 1�% 1/4 of SC 1/4,Section�_,T � N-R Gl E❑or W Q
Township: asfs /s�kf County: Sa,.-y«
ProjectParcellD#: DCa-`�ti��� 21- 11DN
Designer Information
Designer Name: �.-:.�d f G��,�- � Phone: ��f-s��" - i l 3�
Designer Address: �3�Z'�F���'�Qd� 1�,�-�;wr 2ip: 5 yf y 3
E-mail• � _<<.
License Number: %SC///
Remarks:
� /`�r./L�� ,1
Signature:i� Date: 7—�g- 3
� Original signature requi2d o�each submitted copy.
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Septic Ta�k(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA +-�r�}�� �=.y� .
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s)
3-ft Trench (down-sizing credit) ge, 98, gal gal
Eftluent Filter Manufacturer:
�K Lcc i /--�.r��, .
I � Effluent Fllter Model#:
min,1T
SOIL COVER (ryp����
12'
min.Vench
depth
�HP'�'� • TYPICAL TRENCH
� —. " e •: CROSS SECTION VIEW
~i�vPi��� (No Scale)
� �.
' Provide minimum 3 fl
System Elevation = ft separation batween trenches.
(typical)
Quick4 Standard-W
w/End Cap (Show location of inlet/outlet pipe connection on plan view.) �Ose(��tl�l,Ipe TYPICAL TRENCH
(typical) mstan ermanufacmrers PLAN VIEW
P
"�"�"��S (No Scale)
�, , , ,ti - - - - �� - - - - - - - �f- - - - -,� f;-�
���r� � n1Y�IV�S� tf�`/r�l��i��er� A- 3.OR
o -
�.�,.�.;.�. ��
� ��f'���Wrir�.,�(�+.�Lrt -: > ' ' (bPicap
� - - - - - - �f- - - - - - - - �� - - - `.a ��...�.r_ _ � D
F s = S3 ft �; m
�ryP���� Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (cyP���� �
(mfd by Infiltretor Systems,Inc.)
Install pursuant to manufecturers instructions.
� Quick4 Std-W @ 20 ft� EISA/chamber= �C ft' �
+ � Pairs of end caps Q 6 ft�EISA/pair= 6 ft' ��p���2/��,
= Proposed EISA per trench = ��o � ft' Required Infiltration Area= 7�'/����"' Distribution Method:
x 2 trenches = Proposed Total EISA = ���' ft' ���'���,
�
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this inyround 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, ail inspection and maintenance adivities shan be performed by a registered�POWTS Main�iner in
accordance with SPS 383.52 (3), Wisc.Admin. Code.
lliaximum Disnersal/#rea Operatinq Limits:
Design Flow= 3�' gpd; BODS 5 220 mgL"'; TSS 5150 mgL''; FOG 5 30 mgL"'
InsceCtion Checklist INSPECT EVERY 3 YEqRS
o type of use
o age of system
o nuisance tadors.(i.e. odars, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue(i.e., leaks, breaks, corrosion, etc.)
o solids��c�rne in anae!nb�.c treatrnentdank(c��d any distributiert appurtenance(s) (i.e., distrib�_�ion!drop boxes)
o neglect or improper use(i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in disVibution cell prior to dosing
o dosiqg irregularities- if applicabte!i.e., pump re-cycling, float swiu:h settings; etr..)
o electrical components- 'rf applicable (i.e.,wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or Iateral orifice plugging (measure lateral dis[al pressure—compare to design specification)
o surface discharge of effiuent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tank(s1 shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats.when the volume of solids in fhe tank(s)exceeds one-third(1/3)the liquld volume of Uie tank(s)or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
o Effiuent filteNs)shali be inspeded every 3 years and shall be deaned when necessary to remove any
accumulated solids according to manuFacturers specifications. A serviang period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper locai govemment unit in accordance with
SPS 383.55 VYfsc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: �-j j s`rP��t Phone: 7�5 --S-S�'��38
tocal govemment unit: ��%�� �-T✓ Z��>.�-� Phone: I�� F� 3�/- �-�ly
Local govemment unit address: `"7�.� ST_� /�<.i�� , (✓_�� Z�p: S^�dv�
Any defective part of this system shall be repaired, repiaced, or removed pursuant to SPS 383.51 (t), Wisc.Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. 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.
Continqencv 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 dispersai component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POVYfS is discontinued, it shali be abandoned in accordance wdh SPS 383.33,wsc. Admin. Code.
9/29/23, 11 :51 AM Real Property Listing Page
R2al EState Sawyer County Property Listing Property status: Current
Today's Date: 9/29/2023 Created On: 2/6/2007 7:55:07 AM
�' Description Updated: 5/18/2018 '� Ownership Updated: 2/6/2007
---- __ —____ __ _ _.._
Tax ID: 3444 ROBERT A NOVAK HAYWARD WI
PIN: 57-002-2-40-09-21-1 O1-000-000040
Legacy PIN: 002940211104 Billing Address: Mailing Address:
Map ID: .1,4 ROBERT A NOVAK ROBERT A NOVAK
Municipality: (002) TOWN OF BA55 LAKE 15801W WOLF LN 15801W WOLF LN
STR: 521 T40N R09W HAYWARD WI 54843-6558 HAYWARD WI 54843-6558
Description: PRT NENE & PRT SENE LOT 3 CSM
27/110 #7043 � Site Address * indicates Private Road
Recorded Acres: 5.000 15801W WOLF LN * HAYWARD 54843
Calculated Acres: 5.001
Lottery Claims: 1 �-
� Property Assessment Updated: 5/12/2021
First Dollar: Yes
0 Zoning: (A-2) Agricultural Two 2023 Assessment Detail
ESN: 406
Code Acres Land Imp.
Gl-RESIDENTIAL 5.000 23,000 235,000
� Tax Districts Updated: 2/6/2007 Z_Year Comparison 2022 2023 Change
-- _ _
1 State of Wisconsin Land: 23,000 23,000 0.0%
57 Sawyer County Improved: 235,000 235,000 0.0%
002 Town of Bass Lake Total: 258,000 258,000 0.0%
572478 Hayward Community School District
001700 Technical College
�,
�° Property History
� Recorded Documents Updated: 5/23/2018 N/A
_ _ _ _
CORRECTION INSTRUMENT
Date Recorded: 5/21/2018 412443
CORRECTION DEED
Date Recorded: 5/26/2006 339028
QUIT CLAIM DEED
Date Recorded: 8/5/2005 332401
CERTIFIED SURVEY MAP
Date Recorded: 7/15/2005 331870
WARRANTY DEED
Date Recorded: 5/23/2005 330513
CERTIFIED SURVEY MAP
Date Recorded: 4/20/2005 329805
https:lltas.sawyercountygov.orgl/systemlframes.asp?uname=Eric+Wellauer ���
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=`���o�$� ,��, SYSTEMS SaWyer
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"F" INSPECTION REPORT Sanitary Permit No:
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Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �. 3_ 21��
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
I(�.,��"' ND�G1.! �J�iss ��-�'�^ �
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Insp BM Elev: BM Description: �f� y►� Parcel Tax No:
I v� .c�� � b�-c�,��. �� ^� �� -9 Yo —��.-I l o�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ��� �� Benchmark �p�,b�
Dosing
Aeration Bldg. Sewer
Holtling St/Ht Inlet
TANK SETBACK INFORMATION St I Ht Outlet
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation �,.�'g �
Contour
Aeration NA Header I Man. �r'S 3�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative 9 k.3 �
Surface
Manufacturer Demand Final Grade
Modei Number GPM S `�y�3 �
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L � Dia Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N 3� L �(,� (oy #of Cells a Type of System Distribution Metlia Manufacturer:
Conv ❑ Aggregate ^
SETBACK P/� Bldg Well OHWM of Nav o IGP � Chamber '
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO t j` }- $� � �t, � ❑ Mound o Other Q,�,.�
--- -- -- _�— _ _ - - -
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DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) �ole Size X Hole Observation Pipes
Length Dia � Length Dia _ Spac _ , Spacing ❑Yes ❑No_
SOIL COVER
--- _— _ — _ __ _ -
�Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center l Cell Edges I Topsoil f ❑ Yes ❑ No �Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required7� Yes 0 No 03 �a � � �j�j���
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Use other sitle for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS AND SKETCH
SANIT,4RY PERMIT NUMBER:____.�_�- o�Y�__
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