012-640-09-4201-SAN-2021-304 .,�«r�,;, \ County ( ^
= \�- Industry Services Division SaH�yer . �,//'
,(�f� T
- `D S p S �=i ````q OpC`� 1400 E Washington Ave Sanitary�Permit Number(to be filled in �'�'J
� �� P.O. Box 7162 �7'
/�� Madison, WI 53707-7162 �t1l � �^'�
l./ L'S'-r' �a- � �J � ' ^ `
l V
Sanitary Permit Application State Transaction Number
ln accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to W
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Preject Address(if different than maili
u oses in accordance with the Privac Law,s. 15.04 1)(m),Stats. 9096 Trapper Trail �
I. A lication Information—Please Print All Information
Property Owner's Name Parcel tt
William Gleason 012640094201
Property Owner's Mailing Address Property Location "
1918 Raleigh Rd
Govt.Lot ' �
City,State Zip Code Phone Number NW'/<,SE'/<, Section 9 " �
New Richmond,WI 54017 (circle one) 7�
T40N ; R6EorW ��"
11.Type of Building(check all that apply) Z Lot�
� I or 2 Family Dwelling—Number of Bedrooms ✓ � Subdivision Name �
❑ Public/Commercial—Describe Use Block# �
❑ City of
❑State Owned—Describe Use �
CSM Number ❑ Village of
24/100#6526 � Town of Hunter
III.T e of Permit: Check onl one box on line A. Com lete line B if a licable
A. � New System ❑ Replacement System ❑ TreatmendHolding Tank Replacement Only ❑ Other Moditication to Existing System(ex,lain)
B ❑ Permit Renewal ❑ Pemiit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Fxpiration Plumber Owner
IV. T e of POWTS S stem/Com onent/Device: Check all that a I
� Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil
❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dis ersal/Treatment Area lnformation:
Design Flow(gpd) Design Soil Application Dispersal Area Requircd(s� Dispetsal Area Proposed(s� System Elevation
450 Rate(gpds� 643 652 94
.7
VI.Tank Info Capaciry in
� � �
Gallons Total #of Manufacturer � � v o J
Gallons Units � o :: � � � � s
New Tanks Existing Tanks o., U cn � cn ct. U 0..
Septic or Holding Tank 1000 1000 1 W ieser � ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VI1.Responsibility Statement- 1,the undersigned,assume respo ibili or installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signatur MP/MPRS Number Business Phone Number
Dan Burch 253808 7I5.416.1642
Plumber's Address(Street,City,State,Zip Code)
1118N Front Street Spooner WI 54801
VIII. ount /De artment Use Onl
� Ap r ed� ❑ Disapproved Permit Fee Date ssued Iss�g A ent Signatur� ;'
/� � '� �`' G ! �J �.��.(�- �
7/""" ❑ Owner Given Reason for Denial $ �' �"
IX.Conditions of ApprovallReasons for Disapproval � � '
� C�� �� �Vv�` y [/�(
1� a X1
A�� ' � � ��4 � � D ����� !'n i/
G ��, �
� � � ii u�"u' r~�
Attach to complete plans for the system and submit to the County only on paper not less tha t 11 inches in size
� �j��j� �EP 1 5 2021
SBD-6398(R03/14) �{O i-ZtFtJ��I�S i-��TER A------
ISSUE OF P�RMIT �,��n���-� � � � �
� � �-�'� ' � q��a � I I �I Z, � L����i�3��i��l�V�:i�} N.�l�`iV
�
PAGE 1 OF 4
In-Ground Gravity Plan �
index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10/12),,,
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
Owner Name(s): W��l �p4�n �Z�s�^' Phone: - -
OwnerAddress: � �(� ��i �EI G-� 12�� ��ccr�M�-� � �� Zip: ��l o t 7
Project Address: �� �l� �rtt�P���2 �n.����
Govt. Lot: �1/4 of�1/4, Section � , T�D N-R�E Q or W�
Township: ��c� a�-���- County: �i��'1'G '��-
Project Parcel ID#: �0� �.6� ��9 ���i
Designer information
Designer Name: Dan Burch Phone: 715 _416 _1642
Designer Address: N5921 Cty Hwy K Spooner WI Z�p; 54801
E-mail: Burchplumbingine@gmail.COCII This space reser��ed for approval stamp.
License Number: 253808
Remarks:
Signature• Date: �' �`� '� �
Original signature required on each submitted copy.
CHECK BOX AS APPLICABLE. CHECK BCX AS APPLICABLE "
� SOIL EVALUATION o s`a1e: ao 40 so $o ❑✓ SYSTEM PAGE 2 OF
SITE MAP � PLOT PLAN �
PROJECT NAME: ��Z DESIGN FLOW: 4'rJO GPD
Gleason System Attach design flow caiculations for commerciai plans.
PROJECT ADDRESS: 9096 Tfapp@f Tf81I Pipe Materiai/ASTM Standard(Tables 384.30-3&384.30-5)
N Sanitary Sewer: SCh 40 PVC �
BM Symbol: � BM Elevation: �00 FT Force Main: /
BM oes��Pt;o�: lag bolt in east side of 10" Maple
SlopeGradient(%) ` Indicatenorthby IMPORTANT:
of Tested Area: �`� Well Symbol(if applicable): � drawing an arrow Show ground elevation contours at suitable intervals.'
on the approprite line.
�N/s'.�Ew �►
�jt.. {1�.��3 .�o��✓s�GrE
�,� f�J`�� ��LS
�z�
(►�F��'�
1/VE Lc-- ��o �3 � 5�' t �,2 a,,n g�s i E^^
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` � 3 .�i�
o N,�;�
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iJ � � �� ll,:
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'��.� e p E��-- ��.R��.
Septic Tank{s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) �000 gal gal 9a� 9a�
Efffuent Filter Manufacturer:
Polvlok
I
Effluent Filter Model#: 525
min.12"
(tYPical)
SOIL COVER
12„
min.trench
depth •
��vP���> �: � � TYPICAL TRENCH
' • . -� � �� ''��a��-. CROSS SECTION VIEW
�--- aa�� ��� . '; �� � � (No Scale)
(�YP�caQ •;', , . .
� . .,. . ..
• ' Provide minimum 3 ft
System Elevation =94 � separation between trenches.
(rypical)
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (�YP���)
Install per manufacture�'s PLAN VIEW
instructlons.
(No Scale)
�— _ — — , �� - - - - - - - �i� � — ,— - -�
� ; �f, ,�. �� i � �A= 3.Oft
L- - - - - - - - - - - - - - — (�YPicaq �
< ,
�'�- - - - - ��- - - - - - - - - - -� D
�-� B = 64 ft _i �
m
(rypical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: ttyp��i� 0
(mfd by Infiltrator Systems,Inc.) �
Install pursuant to manufacturers instructions. �
16 Quick4 Std-W @ 20 f� EISA/chamber= 320 ft2
+ � Pairs of end caps @ 6 ftZ EISA/pair= 6 ft2
= Proposed EISA per trench= 326 ftZ Required Infiltration Area= 643 ft2 Distribution Method:
x 2 trenches = Proposed Total EISA = 652 �Z branched manifold � �
-��E ,,.� x�,�
PAG.E40F4
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 p�an.
Furthermore, all inspection and maintenance activities shall be performed by a �egistered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= r'( �� gpd; BODS<_ 220 mgL�'; TSS <_ 150 mgL"'; FOG <_30 mg�''
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 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, 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.wher 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 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 component failure or malfunction to:
Name of individual or company: D8n Bl1fCh Phone: 715.416.1642
Local government unit: SaWy@1" COlJtlty ZOCling Phone: 715.634.8288
�ocal government unit address: 1061 O M81►1 St. #49 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.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.