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HomeMy WebLinkAbout024-110-00-2100-SAN-2024-123 �,`A"`", Department of Safety c:°°"ry 5 �/1 ��, �'-�_�`; aw e f T� ,>%; � `� & Professional Services - Z ,a . Z � j- � Sanitary Permit Numbcr(to be filled in by Cc t '>�, �_ � Industry Services Division �-,� � � �S ��-c�-j v� � ,-, ��; ,s � State Transaction Number � Sanitary Permit Application _ yz, In accordance with SPS 383.21(2),Wis.Adm.Code,submission oY this fonn to the appropriate governmental unit W is required prior to obtainiiig a sanitary permit. Note:Application forms Yor state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Services.Personal information you provide may be used for seconda�y purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. �O�i- �S�Gl1� {�� I.Application Information—Please Print All Information Property Owner's Name Parcel#I �v1,n a- Jc.ne�' �j�t le-}-pr1 ��`I -- l/D -OU- a 10 O Propeity Owner's Mailing Address Property Location �1 �1 �1�'1` �' .sE �dE.�e� City,S�ate Zip Code Phone Number C ��A G �.$�MG�� / �N SJ�(°3 _�e'/a,�'!�, Seclion � / _ II.Type of Building(check all that apply) Lot# T�t_N R US E or W �1 or 2 Family Dwelling-Number ofBedrooms 3 _ _ � � Subdf��ision Name Block# �` �Q_��__ ❑Public/Commercial-DescribcUse � W� -- ---- _.. '— ❑Ciry of _ - - ❑State Owned-Describe Use__ _____ _— _ CSM Number ❑Village of _____ — �Ta«�,�t-- i�,d__c�.rc� III.Type of POWTS Permit: (Check either"New"or"Replacement'and other applicable on line A. Check one box on line B.Complete line C if a licable.) `�' �Ne� S stem � y ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreaunen[[Jnit(explaiii) B. ❑ Holding Tank In-Ground ❑ At-Grade ❑ Mound U Indi�idual Site Design ❑ Other Type(explain) (conventional) C. ❑ Renewal F�efore � ❑ Giange of Plumber Li;t Pre��ious Permit Number and Date Issued ❑ Revision ❑ Transtcr to New Owner Expiration ��.� �3� � ,3�3i �� IV.Dispersal/Treatment Area and Tank Information: � ,3$ (�1.,:GK N P J..S Gl�an�e+'S i..i/ � Se�s o�Cn�S Design Flow(gpd) Dc,ign Soil Application Rate(gpd'st) Dispersal Area Required(st� Dispersal Area Proposed(st) System Ele��ation ys-o v. c, �.�o ��a � 8�.sc� �'+ Capacity in Total #of Manufacturer � Tank h�fornlation Gallons Gallons Units � � U '� � ^ New Tanks Existing Tanks � � � � � � ca r n. U �n ti ci� i.i. C7 P. Septic or Holdin�Tank � � IODU � ��G l onG�+�C nc. Dosins Cliamhcr � V.Responsibility Statement- I,the undersigned,assume res sibility for i stal tion of the POWTS shown on the attached plans. Plumbe�'s V�ime(Print) Pluii�ber'' ature MP.MPRS Number [3usines;Phone NumFer i nG�;� �3��-k��':� i� �5a8�g ��s-G3y- 817G Plumbci's Address(Street,City,S[ate,Zip Code) /�/3NlP L.S .�}e,.� Roa.d 77 �/a t,.�etr�� (.:�Z" S�/8�/3 VL C unt /Department Use Only �Ap ro�e Y ❑ Disappro��ed Pemtit Fee D�te Issued Issuing Agent Signature ❑Owner Given Reason for Denial � ��`� �� "������ ��1��`""`""�� ���r Conditions of Approval/Reasons for Disappro,val � _ �,� ��,,� � � � • : r,r� �-� �'-�'�! ��l 7 I `ri;''.i± �• �i r ii��� �iti� �-��a.t� L -���� v ,.�!`,� ` �ate S� �::hk# 3s� � - MAY 1 _B 2U�� �.._-,� � ST a--� _ b�`7 �rr}�'._.j,t�d�__._.��.....�_.,__---__ 'J � aAWY�R COUP�TY NING ADMINlSTRATi01� Attach to complete plans for the s��stem and submit to the County only on paper not less than 8 I/?x I1 inches in size SBD-6398(R.03/22) 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 Stapleton - Big Wolf Island owner Name(s) : John & Janet Stapleton Phone: - - Owner Address: 2101 11th St. SE ; Pine Island , MN Zip; 55963 Project Address : Wolf Island Rd Govt. Lot: 1 /4 of 1 /4, Section � 9 , T 4 � N-R 05 E ❑ or W ❑✓ Township: Round Lake County: Sawyer Project Parcel ID #: 024- 110-00 2100 Designer Information Designer Name: TraviS ButterFleld Phone: 715 _ 634 _8176 Designer Address : 14346W State Road 77 ; Hayward , WI Z�p; 54843 E-mai�: office@butterfielddrilling .com �rE„� s�,��e r«�r�.�a r<» a����r�<��r��� st��r,��. License Number: 652879 Remarks: Signature : Date : oS / ) l, l a y Original signature required on each submitted copy. � ►� � �T SGA LE = I = y a ,�'� �L R N (n �)� w��F IS�A�Sfl, Lo�- at `�� SEc.�9 , �ry�nl � R os'�..1 � Tvwa op �a�ra0 L.RKC v o S�•,•�r E a c o�N-c� � At?G Lft O�'i-11 O�UU 'al C�O U�JI o v �� �' a, Si� I000g.�. ,oce.�b canc.eEe s�,yo��c 'J '° k+.►k n,ac�� br w:csc� �•c.�etc �1.� ��,, ��'e wl l.:�e 3 rmc C.T- �/8 F: /Ftr � , AA� �, Qp ��y lab.sorp�sw� 14ro.� Gor+s:sf.rrf e-E lrwa � �p Celts� SPceed L 31 f c�eu�� CarrFa:ntns * .. �t-o F.�.s �F 3$ OvrcJc y 1�1�• C1..,..Le�3. � `a �e°`�. - �' o �� �� 4o so �o • � ��Q a� o�'`���� � J ��' r Br1= Nc.1 w�R;bbe� rn t 8" P��e V'� p'� (30'�vp e�sF s�d�> y���pvc so�,�to = �� asrhFe�i �� T C- LEv AT ► o1vS nM�► �� � � / /� (3 M !, C� O. c�O �E � 6� 9 0 . c� o .c� s / AP � 6� So . sv �� �� / �/ C33 qd . 9s f� // �►aos E L.f�x6 '� S 1 . ub .�{ // c.r�KE. , �� : r� �a9� 7 �' �. Septic Tank(s) Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete Inc Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s) Volume(s): 3-ft Trench (down-sizing credit} � 000 gal gal gal gal Effluent Filter Manufacturer: Best Filter I Effi�e�t F�ite� nnodei #: GF10 min. 12" (typical) SOIL COVER i2" min. trench depth criP��a�� ��� < �� TYPICAL TRENCH - � • . � � �� �� �� �°�:a� � <. CROSS SECTION VIEW �..�— sa�� � � . �°� �� � � (No Scale) (typical) •;'a , • • n . e .. . a . . ' Provide minimum 3 ft System Elevation — 8�•50 ft separation between trenches. (typical) Quick4 Standard-W w/ End Cap Observation Pipe TYPICAL TRENCH (typical) (Show location of inlet / outlet pipe connection on plan view.) (typical) Installpermanufacturer's PLAN VIEW instructions. (No Scale) - - - - - - - - - - - - - - - - - - - - — � - - - - - - � � � q = 3.Oft I ,�. � r ., , � �' - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - � �tYPical) � �-- B = 79 ft — I G? rn (typical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typical) � (mfd by Infiltrator Systems, Inc.) � Install pursuant to manufacturer's instructions. � � g Quick4 Std-W @ 20 f� EISA/chamber = 380 ftZ + � Pairs of end caps @ 6 ft2 EISA/pair = 6 ftz = Proposed EISA per trench = 386 ftz Required Infiltration Area = 750 {t2 Distribution Method: x 2 trenches = Proposed Total EISA = 772 ftz branched manifold � 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 382-384,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,all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. Maximum Dispersal Area Operatinq Limits: Design Flow= 450 gpd; BODS<_220 mgL-'; TSS<_150 mgL''; FOG<_30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e.odors,user complaints,etc.) o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.) o material fatigue(i.e.,leaks,breaks,corrosion,etc.) o solids volume in anaerobic treatment 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 distribution cell prior to dasing o dosing irregularitles-if applicable(i.e.,pump re-cycling,float switch settings,etc.) o electrical components-if applicable(i.e.,wiring,connections,switches;controls,timers,alarms,etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary) o Septic and dose tank(s)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 ordinance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code. o Effluent filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than�2 months. System maintenance reports 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: BUtt21"f12Id ifIC Phone: �15-634-8176 _ �o�ai go�er„me„t�n;t Sawyer County Zoning &Conservation phone: �15-634-8288 _ Local government unit address: �OO'I O M8111 St, Suite#9; Hayward, WI Z1P 54843 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. 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. 5/20/24, 12:24 PM Real Property Listing Page Real EState Sawyer County Property Listing Property Status: Current Today's Date: 5/20/2024 Created On: 2/6/2007 7:55:39 AM �' Description Updated: 8/4/2020 � Ownership Updated: 8/9/2021 Tax ID: 23456 JOHN W & ]ANET L STAPLETON PINE ISLAND MN PIN: 57-024-2-41-05-19-5 15-223-002100 Legacy PIN: 024110002100 Billing Address: Mailing Address: Map ID: -1.21 JOHN W & JANET L JOHN W & JANET L Municipality: (024) TOWN OF ROUND LAKE STAPLETON STAPIETON STR: S19 T41N R05W Z101 11TH ST SE 2101 11TH ST SE PINE ISLAND MN 55963 PINE ISLAND MN 55963 Description: BIG WOLF ISLAND LOT 21 Recorded Acres: 0.690 Calculated Acres: 0.756 � Site Address * indicates Private Road Lottery Claims: 0 N/A First Dollar: No Waterbody: Moose Lake :-� Property Assessment Updated: 7/18/2019 Zoning: (RR1) Residential/Recreational One 2024 Assessment Detail ESN: 402 Code Acres Land Imp. G1-RESIDENTIAL 0.690 87,600 0 � Tax Districts Updated: 2/6/2007 1 State of Wisconsin 2-Year Comparison 2023 2024 Change 57 Sawyer County Land: 87,600 87,600 0.0% 024 Town of Round Lake Improved: 0 0 0.0% 572478 Hayward Community School District Total: 87,600 87,600 0.0% 001700 Technical College + Recorded Documents Updated: 8/9/2021 '� Property History WARRANTY DEED N/A Date Recorded: 8/6/2021 433817 MAP OF SURVEY Date Recorded: 1/7/2019 19415-21 QUIT CLAIM DEED Date Recorded: l2/21/1981 181438 https://tas.sawyercountygov.org/systemlframes.asp?uname=Eric+Wellauer �/� �U C�1���Q��% 4y _���':• . . �.��b�� ��� �� �y+ /������ � �r��� • Addresses � :..tir y �( ' � ` . . . �r �..��Y�,..�� ., �� .. , � M �`� � .. - Parcels �. '.: �' i" ���, ,s� . . . �.. � . -.,,..r ���. �� ..ic'fJ�'.w. �/l� J � �.•- .�'. '. � .},��� r':,�:. "Vl ��l. . • , ����y, � ������� �""`��"������ �•��,�• � �arcel Numbers � � � �. � . - Towns � � . "�. 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