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HomeMy WebLinkAbout002-940-34-5410-SAN-2023-252 � SAWYER COUNTY ZONING & CONSERVATION ADMINISTRATION � Z 10610 Main Street, Suite 49 Hayward,Wisconsin 54843 � (715) 634-8288 � sanitarian(asawVercounty�ov.or� � 9J COUNTY SANITARY PERMIT APPLICATION in accord with Chapter DSPS 383,Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRIl�'T Property Owner's Name r�,���Legal Description �iL,'_� P� ^�, Sec.3y ,Twp. �� N,Range �W � � l .�- Property O er's Mailing Address Lot Number Block Number �5�oo a — City,State Zip Code Phone Number Subdivision Name or CSM Number i�� �► �� � 5 .�� � > �� �a � , TYPE OF BUILDING: (Check one) ❑ State Owned �ciry Nearest Road ❑Public � 1 or 2 Family Dwelling—No.of bedrooms� � ❑Villa e -t [�„Townof �fj FireNumb �r✓37� ✓ PUBLiC BUILDING/LAND USE: [Explain the use/purpose for this Parcel Tax Number:(12 digit legacy number) permit,(i.e.,campground,festival,recreation/entertainment event etc.)] � O �� � �-,� �-�� � Q TYPE OF PERMiT: Additional Information: ❑POWTS Reconnection(SAN#_-_) ❑POWTS Connection (SAN#_-_� *Attach a Plot Plan with all required information per SPS 383.21 ❑POWTS Revision(SAN#_-_) ❑POWTS Repair(SAN#_-_) *Soil Test Information(CST#�- 137) [�]Other: ° $ ` L\%�1pC�� N � ��S' � v *Gallons per day d 0 RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the installarion of the POWTS acrivity for which this permit is issued. Plumber's Name:(Print) Plu 's Signa MP/MPRSW No: Business Phone Number: 5 " ' 3C`�� (7I5�� � %3 Plumber's Address(Street,City State,Zip Code� 5 7 �1 `Trft�n �� ��� u�����t OFFICE USE ONLY: � �3 ❑Disapproved Review Date: Permit Fee: Date Issued: Issuing Agent Signature (�Ap ro ed� ❑Owner Give�Reason for �O � � (��s9 '��� ��3 �LT�� Denial COMMENTS: **Expires 2 years from date of issue** Expiration date: I 0 ( ����S CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: �� � . 1C v� � � "� ���.�..� _�-� 23 �� ' ���i►� �, ��� _ T � 2 20 .nk� �c c� OC _ _ _�_ __�.. a�- ____. Sp,WYER COU�TT QM Rev.04/21/15 z�N1N 3� ��, NO REFUND.ci AF7EFi I�SUE OF F'�R�(ci� p� ���'�r�r r� r rr,'s�,`•. ,r, �,���. � ; s4WyPY ep., �3�ss (�,� Tw� . � 5'���� 73�n:�D ��� E� Prn1� ooz -. 4�p -��- s�t�D t N�t �r � rN c�v v► ��� c,.�.� 5-� �s� Gaa L� �f 5 3� r Yory R o 4�t! � c.�- a Cs� r4�Z�e f rz/8 � � �p� iY l �,L rr ,��� 5c�e i = 3 a o� � _.�.���. � ..L�� p � g 8�-( koa nQ, � 36t`v� o� � � � Sou�n $e � G>�- Gow¢r�O Ce--�lc��e�, �a � r � B ! �`7.3tf` R�.3't 2 q�.3q ` - a � f 3 �B.�T°I ' � � (..o��-e, $6 t4 g� � � a l�. C'S �v�s,. �K , y�a� � a�', 1tl�`� * � "� t � , , � �/ � i � `j�.t�:i f 1 I� c�� _ __ ,,� � - � �� t ,�<<;���5 t` J' 1 �....�_'-�.�.�,.�� � � q I� 1 � � � . , ! � � ' -- — — � _ " ' ='I — � .. Z .3q' � � q� . � � f ,-- ! D' _ _ — ' � , W � �. y � �_ , _ � �b.�}q , �. __._`__�__� � -� Leo LQ�e � — _ � 9/25l23,2:01 PM Novus-Wisconsin Access rev.13.1108 Redl Estate Sawyer County Property Listing Property Status:Current Today's Date:9/25/2023 Created On:2/6/2007 7:55:08 AM �'Drscription Updated:3/Z/2020 �Ownership Updated:7/ll/2019 Tax ID: 3988 ]EFFREY M&KRI57TN M IMSANDE MENOMONIE WI PIN: 57-002-2-40-09-34-5 OS-004000100 Legacy PIN: 002940345410 Billing Address: Mailing Address: Map ID: :4.10 JEFFREY M&KRISTIN M ]EPFREY M&KRISTIN M Municipality: (002)TOWN OF BASS LAKE IMSANDE IMSANDE SfR: 534 T40N R09W E5200 732ND AVE ESZ00 732ND AVE DescripUon: PRT GOVT LOT 4 LOT 2 CSM 19J228 MENOMONIE WI 54751 MENOMONIE WI 54751 #5681 1/2 INT OL 1 CSM 12/81#2883 Recorded Acres: 1.520 w Site Addr�s *indicates Private Road Lottery Claims: 0 15373W BEACH LN � HAYWARD 54843 FirSt Dollar. Yes Waterbody: Lac Courte Oreilles Zoning: (RRl)Residendal/Rtrreational One -J Property Ass�sment Updated:5/12/2021 ESN: 407 2023 Assessment Detail Code Atras Land Imp. �Tax Districtr Updated:2/6/2007 G3-RESIDENI7AL 1.520 294,300 133,500 1 State of Wisconsin Z_year Comparison 2022 2023 Change 57 Sawyer County �nd: 294,300 294,300 0.0% 002 Town of Bass Lake Improved: 133,500 133,500 0.0% 572478 Hayward Community School Dis[rict Total: 427,800 427,800 0.0% 001700 Technical College . Recorded Documents Updated:6/24/2010 �Property History O WARRANTY DEED N/A Date Recorded:6/24/2019 418418 O TRUSTEES DEED Date Recorded:4/24/2017 406334 0 QUIT CLAIM DEED Date Recorded:9/27/2011 374575 O WARRANTM DEED Date Recorded:9/24/2008 356026 O CERTiFIED SURVEY MAP Date Recorded:il/ll/1997 264363 O CERTIFIED SURVEY MAP Oate Recorded:ll/17/1987 207163 ;/ �! 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' A y�F'�.y P" t k..�v t � R}. 4'\"'fy' . �',� "Fi .F �Y/ ' � lax. i� . r�F w ,f > t� ?q ^ � yt f.��� ;�� 5 d Lp! � �3�'i {�.� i:. �A a� ��t� 0 9 _ $ � � r .. �7 � � d ��-i M � _ e� 1`�� � � ��5�� � 1` ' �eil, :a�j. o rn y� si) �� - o 0 $',. 7 1 . a ,,�-rpy'� �� `. d c ' `-A�[..`dJ -�. ' �wszr .� y� � Z - � . ` ry �njx�I` yl�• .S� i�f�i p u�Ei . . :t �. �.. � � � . � � . ��g � F ,\ j�� � r lT Y � . . . . � . . .U i Q �u _ �_._ _��.�_____.. _ .� __ _ __- _ __. ______ _ _ _.�_ � , "'�� Mdustry Sen ices llivision C uunty � �--+Y � 140D h ��aslung�on Avc ;�"� �, , � � � ._. _ _''�'___t__ ... ._ �p P.O. f3ux 71b2 Seuitary Pcim�t�'�rirtibrt (t�o be tili��l �n = Madison, Wl 53707-7162 "7' _ cs-�- �3 -� 37 � � Z��l `� F--. - _ _ _ _—_.___ __ - - - - - _ ___----- � San�tary Permit Ap licatio `"" '�,'"`"""``°"��N"'��°` In ��cco�'d��ncc with SNS if�3.21(2), Wi�. A:lnt. CuJc, ,ubmfs�iun uf Ihi� Ibnn tu l6c appru�riaw goccrnmunlal inut �� � is reqniicd prior [o obtaining a seniturY pern�it. Note: Application tin�ris for stuto-owncd PC)WTS �re suhmittcd u� Project Addres, (il�differenl Ihan m:�ili� thc Ucpartmcnt uf Safcry x�id Profcssional Sci��ic�ti, Pcnunal iitformadun you ��ro�idc may bc usuJ for scconJury ""'� puipc�ti�ti in ucordanc� �ti�th thc Pi n 3cY L��+, s 15.04{I 1(m). Slats. � ___ __ __ _ __.. _ _ .. .._ ___._ __ .___ � l � � ( .�l�phcxhon Infonnatian Please Print AU Information /" ff - �._ __ __ ��. _ __ _ � I`i��pc,i� O�suri s \;un�� Parc�el ir ` � / J ` ...� (._ti� }'C tt` �\� iJ .�.4+'` `l !�y i V }.} � .--_ _...__ .___ �..}_'..��.sl �.!._�_r..�.�..e��..� � �t J .� __ ^ Propc?'ty O�vncr's Mailing Addresti Property Localicnt r - > _ ._ , G- `� . '� . � , t� 1 � -'V I7 `� `-' Guvt. l.at ,., - — �__ ___ — r ,. ; �/ Cily Stale 7ip Code Phune Ntunbei %,, !�,, Sr�Uon �-% �7 _..___...----- /�� � � ✓��1 c�. � C.� 1 ( {cin Ic ou�y- 1 V I';.:v� ;�r� _ �=_.___ ` -'= -- ' _ 7j^ '_ -- - _ _ ._ _._ � ' �N: r ft i �,� ��? Il. Type ol'Building (check all that appl,y) � ���t u _. ..._.__.. --.._ ..........__ _ (��1 ur 2 Paulily Dwclling -Number of Bedroon�s � � SubJi��itiion Numc --- --- --_.�. I31oc4: t� ❑ PubliclCoinmureial-Dcscpibc U�� - ---....- — - _ _ _ ❑ City c�f _ � _ e.._...._........ � State Owned- Dascril�e Uce CSM Ywnber Village of _ f �,��( ��� � ��� J ��:I'o�on ol' _.__1�ri a'��___.C. .` f�.f� ------ -...............__ �. I1L 'Pypc of Pcrmit: (Check only �nc box on linc A. Complctc line B if applicablc) A. (��� �rw S�°�tem. ❑ Rcpiarcincn; Systcm ❑ �l'rcatmcntitloldiiig 'fauk Repleccmcnt Only ❑ Otlt�r Moditivation to Existing Systcm (cx�fnin) -- --_ ._.._.. �_ ._.... -- - � . . L.ist Prcvi�us Pcnmt Nutnbcr �md I)atc Itsucd ❑ Permit Itenewal ❑ Perim� Itevivion ❑ C�hange ul Plumber � � ❑ Perimt I ninsfer io New � 13cfnrc lix�>u'atiau pu'ncr , _ .. _ �...__. .�. . _ --- --_. .._�_ _______._ .._..,_.. - -- -- ---- . _ .. __ _..� __ ._�_ ___ �__ ._-- .---__ _._---- IV._Type ot'PO�i'TS Svstem./ComponenUDe��ice: (Check ap that applV) �__' _ � ':Von-Pressurized In-Ground ❑ Pressurizcd �t-fsround ❑ At-Gradc ❑ Mound 24 in. oY'suit�blc soil ❑ �lound < 34 in. ofsuitabk coil ❑ Holdi�ig Tank ❑ (�tlier Dispersal Cotnponcnt (explain) _ __ ❑ Pretrealment Dn�icr (cxplain) -.__�.- .___ _�.__._____._..�.__ _._.�___ - -- - V. llispersal/I'reatment Arex lnforroation: � � _. .. . � ' ���...���" - —�-- - -- D�.I�i Flow , d De;i n Suil A �l��uun Ratc >d+ Dis crsal Arca� u�d ti Dn�cr,�l �tc a t ��, �osul {sf} System tilevatiun � (Sp ) S Pl '(8I '� P 9 (� � 1 I - ;. ` C � . ._ F �_ ' � " � _ � _ � _ _ _ _ - - -- - _.. . __ _ ._ _. __. VI. Tdnlc lnfo ('ap:i�ity in Ibtal ti of � rYi:inuFncttver Galluns Gallons Units � a � $ u Vewlunks I[+:istingl�anks �y � o � � y � � � c. :i v; v cn i.� :7 G, _-_. _ .._ ___.__ _.._---- - _ _...__.. . / _`'-` C , _- _. _._ -._. ____. _,__,_ ____. �. ticptic nr Ilolding Tank ) � � � � � ) �-) i � ��-'1! t f ; . . . /�. ._-____._._ . . � �. -----_.�_..�__..... _...___...�_..... ` -----`-`--� - ._..------ ---�- ----- �---__...._._.._ Doning Ch�ml?c��, ._.._-'-- —._�—..._-- ---__ ..--_. --._._.._.__.-v .__�.... ___.-__.__._ ._-.. ____.. ._ __-'� -- -- � VI I. Ite.r�iuntilbilil�' Statcmcnt- l, the undcrci�;uccl, assume C�'�P�����+�rilit�• foY i� �t,dlr�tiuu of the !'U11 I�shuwn on tfie attached plans. f ..—. , �_ . ..-.-.._ _.. .._.. . 1"I�ti��tzer'. Namc t Pr��) Plumbcr's tit�tr:nuri/ � j Mt' �� 1'Rti Nuntbcr I3usinc5s Phm�c Num�cr , � _ { � � , . � r _ _ ��, � �-� 1 , 1 ' / ., i � �.� ,,,, (.'�; , - � �, � a�.,�:� irS� �. � . � � _ ( ,','�-�—�_—__� - _ Plumher's Addiess (Street, City, Stnte, Zip CuJ�� � � � � 1 / �'"' �./ f,� ��,./ Y' ��/�,��1 :� ! ' 7 <</ ��j``--' � /` `�f'<..2= �l,�c. .%�� Lr�!/ � l l_`� J t _ �--- VIII.��opntv�Department Usc OnIV . . _ __ - � - - ti_.. �l -� Pcrnvt Pee �Dute I�,.u�� I � I�..w . �i ti��acilur�- �. j , � �r\Er��l•'� ❑ Uisappro4ed - - - \�i 1 -- -- ' �'������ ❑ (�wncr Givcn Kcasun liir Deniul � d��"'� � ���� ������ � � .j� r' � ^�5i�`l � IX. C:unditiuns of ApprovallRe�sons far Diss+pproval r � � �� � ?�. NO flEFUNDS AFTER ISSUE OF PERMIT _____- -_ — ----�_ - ;;- - � ��-- ,�Itach [o cumpictc pinnti for tAc sysicm and submit tu Ihc Countv� �ni� un paper nut Icss tlron 8 �, '� � i r`����,i .� �' .-� ...... �_`�.�_�,� �_1, � .7 �_: - : 1 (� _,,; �% �-`��- JU�I 0 9 2020 ; __ 5BI)-63)8 (R. ORi]4) _�__.____.__ _____-: , SA1NY�={� �,t�. ,�,,.-1-t� L J _ , zo��rv� ar�h�ir��:;���.�Y,:���r�, PAGE 1 UF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manuat Design References: Versian 2.0, SBD-107Q5-P (N.01/01, R. 10/12} 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: Encic�sures: �mm�f��� �� -- y �-M ��� POWTS Application for Review ------ -_ -- --- ____._. _ __�__._ __ ___-_ _. Soil Evaluation Report & Site Map Project Name / Description � — Owner Name(s); `�'��" �-�� �"� S'��� U' Phone: - - � a,.. �r��. Clwner Address: � � ���J ___.. � � �:�y) ;�'� `u -�w� Z�p� .��`/7�,�r � - - Project Address: , ��'/� Govt. Lot: � �� "�_ ____1/4 of ___ _ _1/4, Section �-� `( , T `� � N-R_�_��E�or W '�� Township: ___�=� �> � � � 1�+�' County: Project Parcel ID #: �� � `� `� � 5 `� S� `� � � Designer Information � ` z Designer Name: �, , /� � l �t� �� �- �� Phone: - - Designer Address: �/���I��� { ,�� r -�` ��� ` �� ��� �� ���� Zip: .��{�`� � E��lal�: �..� i.� �� ��, �'�1�,�^j(��1..•,"- .��� �'l`t+ � , � D rtn � � I»a-. , �n'.'< �' i� License Number: � j� � :;' �� �' � .,�,__, -�r � �__� ► '' J��`'��i����/a� �,�'s� Remarks: � � _..�_ _`��� t �_�� �U N 4 9 2020 -1 _ __.___..__ ____ __� � SAWYER COUNTY ��` �C�#�AI3Mt�lISTRAT1CiN /,° ' �f �� � � � Signature: � Date� r � - a � Oric�Irir�l signatiirc,roquir�zc!on�r3cYi sukarniitQci copy. p /k� Sep!ic Ji ank(s)Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA �^°' - Uniform Elevation Trenches with Quick4 Standard-W Chambers , SepdcTank(s)Volume(s): 3-ft Trench (down-sizing credit) `� � ��ga� �� 9a� 9a� `'� tfFlu�pt Filter Manufacturer. '��-`"' � t_f����t � � �� � ' k �` � Eifluent Filter Model tk: �� �� min.12" (tYPi cal j �--��^�-, SOI�COVER ID� 12s i. min.trench t�,p�,� � TYPICAL TRENCH • - '.a ��. CROSS SECTION VIEW F--��� ... . ' . � (Na Scafe) ,� a.. . :. Provide minimum 3 ft System Elevation= �� ft separation between trenches. (typical) Quick4 Standard-W w/End Cap Observation Pipe TyP1CAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) c�vp+�> (typi�al) Install per manutacturers PLAN VIEW mstructions. �N O .S Ca�e� - - - - .__. � _ .,�./ - - �- -� � '; 't �'� aQ 7a — /� — — ——��#IdF�pf � ��� � ����'�"k�, i�x��'���+r��� s � ;��'��,� �`�/�- - - - - - �� � �e� �a� �A= 3.0ft a` �.n�: (���a � �,r�.i�.��'�r����r� � �'� — — — — ��- — — — — — — — ��— — — — ��s,��sax� .�.��������i - - - - - - B _ ��, � _ i tll (hP���) Quick4 Standard-W Chamber W (typical) � INSTALL PER TRENCH: {mta by�n�in�torsysterns.��o.} � -�, � ��#1I � lnstal!pursuant to manufacturers instrucFions. � i;� - Quick4 Std-W @ 20 f� EISA/chamber= i �` r + � Pairs of end caps @ 6 ft2 EISAlpair= �j_ ft2 =Proposed EISA per trench= " � � ft` Required Infiltration Area= `�"� �ftZ Distribution Method: x �` tre�ches = Prcposed T�ta! EISA = � t�` '`��i�L'�f�-. .����.. RESET PAGE40F4 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 oi SPS 382-384,Wisc.Admin.Code, Pursuant to SPS 383.52(2),Wisc.Admin.Code,this system shall be considered a human heaith hazard if not malntained in accordance with this approved management plan. Furthermore,all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. Maximwn Dispersal Area Operating Limits: Design Flow= /� % � gpd; BODS 5 220 mgL-'; TSS<_150 mgL''; FOG 5 30 mgL'' Inspection Checkiist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e.odors,user complaints,eic.) o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.) o material fatigue(i.e.,leaks,breaks,corrosion,efc.) o solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes) ., neglect or improper use(i.e.,exceeding design capacities,prohibited activitles,etc.) ., extent of ponding in distribution cell prior to dosing ., dosing irregularlties-if applicable(i.e.,pump re-cycling,Float switch settings,etc.) ., electrical components-if applicable(i.e.,wiring,connections,switches,controls,timers,alarms,efc.) o distribution lateral or lateral orifice plugging (measure lateral dislal pressure—compare to design specification) c surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when neeessary) o Septic and dose tank(s)shall be pumped by a certifled septage servicing operator licensed under s.281.48 Wis. Stats,when the volume of solids In the tank(s)exceeds one-thlyd(113)the liquid volume of the tank(s)or as required by local ordinance. Disposal of contents shall be pursuant to NR 113,W isc.Admin.Code. o Effluent filter(s)shail be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids acwrding to manufacturer's specifications. A servicing period will always be greater than 12 manths. System maintenance reporls shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc.Admin.Code. Report any component failure or malfunction to: Name of individual or company: `�L l � 4 � �/"'��,`^ 1 __Phone: ,�/j- �( / [—, /�,y_� Local government unil: ��C✓' / r r� ��:� y" Phone: �! S ��� �'��� __ . _ Local govemment unit address: 5 '� .� /y � ,� S i 1� �L Z�P __.��-(�"/, % �i L��;' � Any defective part of this system shall be r paiYec� reblaced,or renioved pursuant to SPS 383.51(1),Wisc.Admin. Code.Repair or replacemenl 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 depaRment 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 dispersal component in a pre-determined area of suitable soils. Svstem Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.