HomeMy WebLinkAbout024-110-00-2100-SAN-2024-123 �,`A"`", Department of Safety c:°°"ry 5 �/1
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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±
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�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.
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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 �/�
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