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HomeMy WebLinkAbout014-942-28-4307-SAN-2024-035 Department of Safety c°°°ty � � � & Professional Services, � ' � a = Sanitary Permit Num er(to be filled in by C �= Industry Services Division � i� 5� —� 3y � State Transaction Number � Sanitary Permit Application � In acwrdance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmenial unit �— � is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing address) the Deparlment of Safety and Professional Services.Personal informadon you provide may be used for secondary I �]U �'y� � ��� �i'�.�L��/ purposes in accordanee with the Privacy Law,s. 15.04(l)(m),Stats. ��' 6 0 �"u --�a I.Application Information—Please Print All Information l�G(,!'T� Property Owner's Name Parcei fl � � � � � `� . ., c�l y—�1y�—ag—�3�� Property Owner's Mailing Address Property Location L ` �`�' i�( �'�J��•��Z`{`1�.- /v � �°�C' City,State Zip Code Phone Number r. p� S� '/., SL' '/<, Section �0 cu or+� N 5 � II.Type of Building(check all that apply) Lot# � T �ci�N R �� E or� �1 or 2 Family Dwelling—Number ofBedrooms__�_ Subdivision Name Block# ❑Public/Commercial—Describe Use � ❑City of ❑State Owned—Describe Use CSM Number ❑Village of 9�I o� �(47� §iTo�,of L��►c��-f- ili.Type of POW7'S Permit:(Check either"New"or"Replacement"aod other applicable on line A. Check one box on line B.Complete line C if a licable.) A. ❑ New System ❑ Replacement System �O e odification to Existing System(explain) ❑ Additional Pretreatment Unit(explain) � B. ❑ Holding Tank �In-Gmund ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain) (conventional) C• ❑ Renewal Before ❑ Revision ❑ Changc of Plumber ❑ Transfer to New Owner �st Previous Pernut Number and Date Issued Expiration o6 ' a.� $ � iV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Glevation �, � � GSI, � .�5� Capacity in �I'otal #of Manufacturer a: Tank Information Gallons Gallons Units ,s, ;? v � � N � New Tanks Existing Tanks � o ?? � � ,n � � n. U �n � ri� w C7 a. Septic or Holding Tank �D /_� /�Q� �J dv -r'a , �Q' C9 6 .s� Dosing Chamber V.Responsibility Statement- I,the undersigned,assume responsibility for instaliation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum 's Signature MP/MPRS Number Business Phone Number �. C � _._.._..._...� �(U� '�7�5'�l1� Plumbe s Ad ress(Street,City,State,Zip Code) ��-7 !�l �1�2v� `� � 7C � �l'�- ��� �� �� ic.�Z- �y ��1� VI.Coun /Department Use Only y Permit Fee Date Issued Issuing Agent Signature �A d� �Disapproved g ��`� 3�� � �� �,l�.�.�i-i'(ULt.I/1_ ❑Owner Given Rcason for Denial Conditions of ApprovaUReasons for Disapproval D �':��I; �'�� "�� ', ,�,,,,�' � � _--. / � � ; . � �r J�� r • ;- � i �. , . _..__.__... ��� � ���+ FEB 2 9 2024 �-- ��k;: �u N $ _.__ ..._ . J C 5 ` O� � �.�� SAWYER COUNTY l,��I ZOfVtNG ADMfNISTRATIQ� Attach to complete plans for the system apd submit to the County only on paper not less than 8 I/2 x 11 inches in size ��I��FUJ�IDS AFTER � $��� SBD-6398(R.03/22) I�SU�OF PERMIT PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manua!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 Pian 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 , � Ir Owner Name(s): I(� ' �L� I��'�L°G�_ �%1}�(�'� Phone: - - Owner Address: �;z�fi'1�(I�'1,('(��, ��;7f'�r�lf ,L(,/LYJI"� l�N' Zip: ���d.j Project Address: I ,�Z�.�,�1 I� ��1� 1-�.00,�-�'rt1YGt��E aw W Govt. Lot: 1/4 of 1/4, Section_j��, T��N-R C�j E Q or W� Township: ���[)� County: ����L�-�-d� Project Parcel ID #: �4 L},�Gf� r� '��-�S���� Designer Information Designer Name: � �l �^ Phone:'�l��� 1_� � � Designer Address: U '1'� � �- � � Z�P� J��— E-maiL• �C�u���'�� . , License Number: ����� � Remarks: �' Signature: Date: `�—o���"� U ' inal signature required on each submitted copy. � . ; ; ; �� ��,� � _ -1 ; � � ; _i i. _ ; . ,, . .; , � .. , _ . . i ;`�Qq• .. j,6� - '-- 4. � . ; . ;. . ., -�� �- - ; .. �. . , 1 I � i � , � (�: �,, � __ � ; ; I ' , : �� � •- �, -- -� � • -t... i C!` '.t,-.q_.._ . . . . , 'j . , { .. _; . �. . �i .. . . ..--+ ,, ; . . �_ 1 . . �I -�'''� ;- � � -- , . . +_ � � : . . :_ , _. • _;�'A- - ; ; . � . _. . � . ; i . �� ; , , . , {--� • , + r- - . . , � !_, , . ' _. ; , ,_ �_..l. �_ : _ . _t �. .. ; l .. . j . :_ ' , . . _: ? 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' . -� �-�-- - - . .�. _.� 1... _ _._�._...�_�._ — - -�- s.._ , - -1 -� -� _�_._�_ , , -i- --}_ �� � . � { t f � • l � 3 ' ' � � i_..._�..._-.�_..ir__1.___-L---' � ---•-- . iy .._.1..--.t'- ,__..._ ._i._-. ___.? ....: ._.:.. ...._.+�._.� -_ '' ..1_' -' -1--. -'_ . __._ . ... ' . �.Z � 9� :b38WfIN 1lWd3d AdVlINVS - , id�13�3 aNV S1N3NIW0�ItlNOWOW 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 of SPS 382-3&4,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,alI inspection and maintenance activities sha�l be pertormed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. Maximum Disoersal Area Ooeratinq Limits: Design Flow= �!5`D gpd; BODS 5 220 mgL^; TSS 5150 mgL''; FOG 5 30 mgL"' Insaection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e.odors,user compiaints,etc.) o mechanical malfunction(i.e.,pumps,valves,switches,Hoats,etc.) o material fa6gue(i.e.,leaks,breaks,corrosion,etc.) o solids volume in anaerobic treatrnent tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes) o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.) o extent of ponding in distribu6on cell prior to dosing o dosing irregularities-if applicable(i.e.,pump re-cycling,float switch settings,etc.) o electrical components-if applicable(i.e.,wiring,connections,switches,controls,timers,alarms,efc.) o disfibution lateral or lateral orifice plugging (measure Iateral distal pressure—compare to design spec�catlon) o surface discharge of effluent or sewage 6ack-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary) o Sentic and dose tankls)shall be pumped by a certified septage servicing operator licensed under s.281.48 Wis. Stats.when the volume of solids in the tank(s)exceeds one-third(1/3)the liquid volume of the tank(s)or as required by local wdinance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code. o Effiue�t filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's spec'rfications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc.Admin.Code. Report any eomponent failure or malfunction to: Name of individual or company: Phone:�'S���Y��✓ Local government unit� Phone:�(�J�IL���7y C�d25 t� Local govemment unit address: � ZIP: ���J Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51(1),Wisc.Admin. Code.Repair or replacement 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 department in accordance with SPS 384,Wisc.Admin.Code. Contingencv Pian 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 shali be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. 2/28/24, 10:47 AM Nows-Wisconsin Access rev. 13.1108 Real Estate Sawyer County Property Listing VropertyStatus:Current Today's Date: 2/28/2024 Created On: 2/6/2007 7:55:31 AM �Description Updated: 4/1/2020 � Ownership Updated: 5/21/2021 Tax ID: 18488 RICK&ANOREA B DIMON BAYPORT MN PIN: 57-014-2-42-09-28-4 03-000-000070 Legacy PIN: 014942284307 Billina Addr�s: Mailing Address: Map ID: .15.7 RICK&ANDREA B DIMON RICK�ANDREA B DIMON Municipality: (014)TOWN OF LENROOT 285 PRIMROSE PATH N 285 VRIMROSE PATH N STR: 528 T42N R09W BAYPORT MN 55003 BAYPORT MN 55003 Description: PRT SWSE LOT 3 CSM 9/102#1876 Recorded Acres: 0.550 � Site Address * indicates Private Road Lottery Claims: 0 12482N HARD ROCK CIR HAYWARD 54843 First Dollar: Yes Waterbody: Nelson Lake Zoning: (RRl)Residential/Recreatlonal One u Property Assessment Updated: 5/6/2022 ESN: 400 2024 Assessment Detail Code Acres Land Imp. G1-RESIDENTIAL 0.550 160,500 230,400 � Tax Districts Updated: 2/6/2007 1 State of Wisconsin 2_Year Compariwn 2023 2024 Change 57 Sawyer County ��d: 160,500 160,500 0.0% 014 Town of Lenroot Improved: 230,400 230,400 0.0% 572478 Hayward Community School District Total: 390,900 390,900 0.0% 001700 Technical Coflege • Recorded Documents Updated: 6/20/2014 �a�.Property History O WARRANTY DEED N�A _ . . .. _...._ . .... ._.. _ . Date Recorded: 5/20/2021 432005 � WARRANTY DEED Date Remrded: 7/20/2006 340353 O QUIf CLAIM DEED Date Recorded: 9/12/2005 333342 O QUIT CLAIM DEED Date Recorded: 9/12/2005 333341 O CERTIFIED SURVEY MAP Date Recorded: 6/27/1982 183856 1l1 https://tas.sawyercounrygov.orglAccess/master.asp C 1� Addresses � .' '.'.. -t ^� #9 ^r'� .' �����_ l�tTt",�*����a° ` ' � w-�3`.L a w7`_ ���,�i�'' ��i 1l�iitY�`��6 a : ,+...��.�,_ '� 1.' Parcels M+�. • •���; �` '� j�r-� ��r'�rr p,, . : S 'i �. 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