028-742-28-5407-SAN-2022-300 _-"' Department of Safety c°°"ty SAWYER �
~ � & Professional Services, Z
� _' � Sanitary Pcrmit Number(to be tilled in by
3 - Industry Services Division
: . � t� 3� a-� � �
Sanita� Penl.11t A „p11Cat10n State Transaction Number �
t��l 1 NA W
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit _ �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing G
the Department of Safety and Professional Services.Personal information you provide may be used for secondary '
purposes in accordance with the Privacy Law,s. 15.04(()(m),Stats.
I.Application Information—Please Print All Information 1 1�Q(�W BQYS CAMP R�A�
Property Owner's Name Parcel#
ROBERT A. & SUE A. LEBBY 028 - 742 - 28 - 5407
Property Owner's Mailing Address Property Location
6101 EAST PASEO CIMARRON 4
�o�c.Loc
Ciry,State Zip Code Phone Number
TUCSON, AZ 85750 715-462-3254 i.,--'i•, s����o� 2g
II.Type of Building(c6eck all that apply) Lot# T 42 N R 07 [:�dr W
C�or 2 Family Dwelling—Number ofBedrooms � 1 Subdivision Name
B�o�k# NA
❑Public/CommercSal—Describe Use *TA
!r ❑City of
❑State Owned—Describe Use CSM Number ❑Village of
�11656;VA,P15A C3'�own of SPIDER LAKE
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.)
A' ❑ New S stem
y �Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding Tank ln-Ground ❑ At-Grade Mov ❑ Individual Site Design ❑Other Type(explain)
X(conven4onal)
C- ❑ Renewal Before ❑ Revision ❑ Chan e of Plumber ist Previous Permit Number and Date Issued
g ❑ Transfer to New Owner
Expiration NK
IV.DispersaUTreatment Area and Tank Information:
Design�lOowo(gpd) Design SoilOApplication Rate(gpols� Dispersal Area Required(sn Dispersal Area Proposed(s� System Elevation
� 857.15 900 98.50 FT.
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � ; o b„ v
New Tanks ExisNng Tanks w = � � v v n m
� p � N .D � c0
C1. CJ V] C/] LL C� L1.
SepticorHolding7ank 1200 12�� 1 WIESER COMB ) A
Dosing Chamber g� p00
O
V.Responsibility Statement- I,t6e undersigned,assume responsibility for installatlon of the POWTS shown on the attached plans.
Plumber's Name(Print) Pfumber' Signature MP/MPRS Number Business Phone Number
�� � �4 � �l — . -��P�3
Plumber's Address(Street,City,State,Zip Code)
l�J� l I'� av /2e9� t s W� ��C
VI.C un /Department Use Only
�{ � � Pennit Fec Date Issued lssuing Agent Si�mature
4�APP �" ❑Uisappro�ed
�W ❑Owner Given Reason for Denial � L�'� � � I �g(a-'� � '
Conditions of Approval/Reasons for Disapproval �( ' D � �5��5��
l 0 l� a� �5 �v
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. ... NGtnJ 1��r I ol �3 8c�� , O�� � O LO�L
C S� �a- — � I S �Y'�!H- SAWYER COUNTY
ZOMNG ADNffNISTRATlO[V
Attach to complete plans for the system and submit to the County onl�on paper not tess t6au 8 U2 x 1 I inches in size ' t O(� I�
NO R4F:JNDS AFTER �'
SBD-6398(R.03/22) ISSUE OF P�RMI'�
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index � Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index 8�Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section 8�Plan View
Pg 4 of 5 Pump Tank Specfications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
�uR�� tiv�P Soil Evaluation Report 8�Site Map
?�.r.ID STA7EMEn)r
Project Name/Description
Owner Name(s): ROBERT A. &SUE A. LEBBY Phone• �15 _462 _ 3254
Owner Address: 6101 EAST PASEO CIMARRON,TUCSON,AZ ZiP: 85750
Project Address: 11009W BOYS CAMP ROAD, HAYWARD 54843
Go�R.Lot: 4 1/4 of .1/4,Section 28 ,T42 N-R�� E❑or W ✓❑
Township: SPIDER LAKE County: SAWYER
Project Parcel ID#: 028-742-28-5407
Designer Information
Designer Name: MARY JO HUPPERT Phone: 7�5 _426 _ 1775
Designer Address: 25720 FIREFLY LANE,WEBSTER,WI Z;p: 54893
e-maii: hollisterdesign@outlook.com
License Number. 1859-007 : -;' �
Remarks: �,.* f<` � "�;�_
- t:. ,
- t • ,
� •4'�.t r .i.' _
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% ., ..
i�� /S: ��.
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Signature: � �li d !iL �� Date:/��;,6���-��.;�6,�2022
'�2w��eacn s�,emntea cavr.
Plot Plan � � ��
�
�---;
PROPERTY OWNER: RoBExT �t. � Su� � . LEaay 1., __ � �
(except where noted)
legal Desuiption: �RT. Cc i;c�rt. LnT'-�� �5M #1 l�hb� V g� pGGE• STC. ZS?42 AI �] =p�k� �
gpy�.J. TowN oF SPIDEf( LAK�F 5�wY6R CouuTY t��i - ,:r��< r�l
� (o.358 ht'Ft6
028- 742-�- 5�/D7 � ilooq � TSoyS C�MY {ZoaD '`�
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Site location:
� �
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
'
I min. 12'
c�'eX'�� I I c�vP���> TYPICAL TRENCH
cover
SOILCOVER CROSS SECTION VIEW
12� (No Scale)
min.trench ' s . OBSERVATION PIPE DETAIL
dep(h (No Sraie)
(typiCal) �' — r — — , � Screw-7ypeor
Slip Cap Qoose) Finis�ad Gratle
/�o.Co e ' (mulched&6eetletlj
System Elevation = � � fI �' 4"0 PVC Pipe Topsoil Cover
(typical) � Pfovideminimum3ft roPorP���o�e�ma�a (m��.imop
at or above finisheE g2da
separation between trenches.
(4)1/4••1/2„X 6"Slots
�eD apart
TYPI CAL TRENCH (Show location of inlet!outlet pipe connection on plan view.) A„�ho�„9 oe,;� o-,ri�aao„
PLAN VIEW s°�dCe
(No Scale) 4a� Observationpipashalibeinstalletl
at junction batwean iwo units. �Q
Perforated Lateral Observation Pipe ft
(typical) (rya��q (bPioap
— - - - - �f - - - - - - - - - - - - - - - �
� — — —_- —_ ___— _-__' _' '__ '_"___— ___:___= I A— 3.0 ft �
— — — — D
- - - - - - �s- - - - - - - - - - - - - - - - - - - J cry���> �
F B = so ft _�� m
(�yPicap W
INSTALL PER TRENCH: EZ1203H Bundle Q
(rypical) T
6 10-ft bundles @ 50 f� EISAlunit= 300 g� (mfd by Infiltretor Systems, Inc.) �
Install pursuant to manufacturers instructions
+ "" 5-ft bundles @ 25 R' EISA/unit= -- ft'
= Proposed EISA per trench = 300 ft� Required Infiltration Area= $57.15 ft� Distribution Method:
x 3 trenches = Proposed Total EISA = 9�0 ft� branched manifold �
R G ' ! ROBERT & SUE LEBBY
PAGE 4 OF 5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
4'9VeniPipe (No Scale)
>70 ft from
Building Eleclnral must mmply with
12'Min.or 2.0 fl above COMM t6 and NEC 300
Es�a6lishetl Flood Elevalbn W�����f Erztend manhde nser as necessary.
(HPi�I) Junciion Boz
Apprwed
Venl CaP Approved Lockirg Manhole
IMPORTANT: wi�h Waming Label Allached
Anchor tank(s)as necessary � � �ry�����
�Conduit
pursuant to SPS 363.43(8)(g) d"Min.w 20 R above
Established Flood Eleva�ion
MP���)
�AirtightSeal �_
Finishad Grade
- Quick DisconneU �
CAPACITIES 22.24 - 1e•M��
@ 9a�n . . cryw�p
Depth (in) Volume(gal) • a �
^ TT �
/�y �9.� 422.�J6 * ' \ �,IW�P - �Avmovea.wimswNi
` :'Hole APWweE Pipe 3 ft«M
B 2.0 44.48 � Liquid sorac�o„w
A Depth ',. Force Main (Ho'��
[C] 5.0 111.20 � F�ite�*
D 10.0 222.40 II�A�a� `�nstall and maintain pursuant
B on to manufacturer's inshuctions.
r� PUMP-OFF
* 36 T P"`"P rnr ELEVATION = 92�83 ft
Pump Tank Liquid Level = in
�
Force Main Diameter = 2 in � c�,��e INSIDE BOTTOM
B'°�'' ELEVATION = 92•00 ft
3"Approved Bedding Matenal Beneath Tank
Force Main Length = ft
56 FT. X 1.39/100 FT. = 0.40 FRICTION FACTOR
Force Main Void Volume = � �j gal
56 FT. X .163 GAL/FT. = 9.13 GALLONS FLOWBACK
[C] Total Dose Volume TDV = 11 1.20 gal/dose ��120 GAL - 9.13 GALS = 102.07 GALLONS / DOSE
(<0.2X design flow+force main void volume) 600 GPD / 102.07 GALS/DOSE = 5.9 DOSES / DAY
Vertical Lift = � �� ft 98.50 S.E. - 92.83 = 5.67 + 0.50 INVERT + 0.50 FILTER LOSS +
0.40 FF = 7.07 TDH
PUMP TANK: SEPTIC TANK(S1:
Volume = $�� gai Total Volume = 1200 gal
WIESER WIESER
Manufacturer: Manufacturer(s):
Pump Manufacturer: ZOELLER
install approved force main filter pursuant to
Pump Model: 98 manufacturers instructions.
(See attached pump curve.)
Controls/Alarm Manufacturer: SJE RHOMBUS Filter Manufacturer: NEW SEPTIC SOLUTIONS
Controls/Alarm Model: AB TANK ALERT 324
Filter Model:
Float switches containing mercuN are prohibited.
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SPS 382384, 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 Dis�ersal Area Ooeratinq Limits:
Design Flow= 600 gpd; BODS <_220 mgL^; TSS 5 750 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 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 distrtbution 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 Seotic 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. Disposat of contents shall be pursuant to NR 113,Wisc. Admin. Code.
o Effluent flter(sl 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: RYAN STRAND Phone 715-558-1673
�oca� government unit: SAWYER COUNTY ZONING pnone: 715 - 634 - 8288
Local government unit address: HAYWARD, WI ZiP 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 maifunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product tor 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.
' , ,�o o ��,
,a„ � HEAD CJ�PAC�TY CURVE
'g' � YOOEL "9� 4 5�8 -�{
70 �
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6 p �
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IS O I
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ott �
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NOOEL GE 60 C�'Q.E
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CO(VSULT FACTORY FOR SPECIAL APPLICATION�
E�earicel aNema�ors, tar d�w�x�. �e aysYel�le aid • veriaem►evel aoet swieotbs are avaYd�le ra�9�
suppYsd witli an alaern. ared Marae Pheee sysfems•
Mechsnices ei0err�Ors.for duplex Sys�rt�.ete avedle6b • Dafile P�99Y����level Iloat swiiches are available
wiU1 ar tYfllecllt alertn switchss- fOf�rariaWe I�VB11ong aYde�Nro�s.
3ELECTION GUIOE �
1. YOsQd b�1 apenYd 2 Yd�m�drnid swildi.ro eidemai mNd na+k�d_
Standard ali models -Wti ht 39 14s. - Y:H.P. 2 srq�pppye.�vararw.��os+*.r�Qeo�+�epoa+'�•d�°1si°�.
M 8rf.s Ceweral 8alserw d MA.RYv n FMM77.
YOON VOMi# H�OI pY 3N�dlvrCdWmYatOOW20�lU-OQ75.
MYp 11S f Aub oA tot87 — a. SrFM07t2.boae�Cmod,ldEMttrfdAlhm�lor.
v, i Gonao�a�aw 10�GR,�5 uwa M.omrd.riw�or.p�%Y A�o�(3)a 1/)
11Bo 173 1 Non bt y�Mn.
oee za0 � � �.s �a�a� — arwH)nar.Fvaa.►�+�m�.ro�..�.�4�+m.rm�a.r.aa,
�e bo � rea� a.� s>s a e 3 or a a s �. T�l�mis�.wak,wr�werrtlyM mnwe^«cpri.
;aunou
r���m�b�'���b��p�yyii���g�yyid AllimlIDlallonofcenVolcpmtcetlondovicezantl�.iirin9shoultlbo�bnuEyaQuollfME
�n:�d�.���y��.p�p�ypy�ey,�; s�a.d.iac�riwn.ateiectdoaia�es,mir��nshowuoeiwoneaiMwamymemosi
����������R�� nce�.Natlonal Efectric Cotle�NECI anC Ihe Occupalbnal5afety eiM HeallhAc�(OSHAI.
RE:���K�VE POWEF2�L� ��3it��v
For urrisual�di�o�a resene safely facbr is engineered 'mto fhe cfesign of every Zoeller pump.
_ _____'_ rLL 71k P.Q E01(fOR .
Jy�1�i.KY�7 � 1Y�d�od..
`O. � �[a�Yrr.�/-7f0� �n'�w►.�,�
�l//19� L�O. � r�ex�nss�
+�.m+�.�a* --- --- . —
.-. _. ,- . ... _ . . , _ .rni -
""�'''�?� PRIVATE ONSITE WASTE TREATMENT county
/:�-— �,,,,
' � S awyer
��`� o \\1�1 SYSTEMS
-���SPS ; �
''��� ��� POWTS)
\�N\�-4�'`�
�ss,"�'='' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� ��pp
Pe�onal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village �i1 Town of: State Plan Transaction ID#:
� ���,�. �.e.b� S i O.�r (.Q� --
insp BM Elev: BM Descripti . Parcel Tax No:
��.o� ��, �-F- 5;�� o�- � r�. ���; o�-�Ya ��� -S--Yo�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic U,�� _ �2pc� Benchmark �po,o�
Dosing Co �a 8� � Q�.$��
Aeration Bldg. Sewer t�gD �
Holding St I Ht Inlet yS,Sy�
TANK SETBACK INFORMATION St/Ht Outlet q�3'
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet -
AIRINTAKE
(
Septic k� t�o9' S` .�S ' NA Dt Bottom 4(.�.y
Dosing „ �� „ ,� NA Installation
Contour
Aeration NA Header/Man. �.�
Holding Dist.Pipe
PUMP/SIPHON INFORMATION Surface e 47.7.��
Manufacturer � Demand Final Grade
Model Number q� GPM N� �• 1�'oZ� r
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L ��(3 Dia o2'` Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 L �p� a� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav
Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG f� EZFIow
CELL TO `to ` ��j� .�-�oo' -�-�b' ❑ Mound o �ther
DISTRIBUTION SYSTEM x Pressure Systems Only
_— _____ _ --
Header/Manifoltl Distribution Pipe(s) —' X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac �_ Spacing ❑ Yes ❑ No �
-- — —— --- __-----
SOIL COVER
Depth Over Depth Over �Depth of Seeded/Sodded Mulched
Ceil Center �Cell Edges , Topsoil__ _ _ _I ❑Yes ❑ No ❑Yes ❑ No�
COMMENTS: (Include code discrepancies, persons present, etc.)
���lla� I l (3�a.�
_ � -
--
Plan revision required?❑Yes � No �3 (3 �-�I � / � 64'S� ��
� -----—lti
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBER'_��=�
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