The URL can be used to link to this page

Home My WebLink About010-133-00-0300-SAN-2022-045 ,�i�.kriri��y.. County = Industry Services Division Sawyer ?�� , ��'^ 1400 E WBShIIIgtOil AV2 Sanitary Permit Numhcr(to be filled in by Co.) P S P.O. Box 7162 ' � ::; ` Madison,WI 53707-7162 '-- � lv3 g�5 I �- �;,.,<,..,�:` Sanitary Permit Application s`ate T`ansa°t;°"N""'h�` �, In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis fonn to the appropriate govemmental unit � is required prior to obtaining a sanitary permit. Note:Application forms for state-o��med POWTS are submitted to Project Address(if different than mailing address) � the Department of Safet� and Professional Servies. Personal information you provide may be used for secondary Lot 3 Hidden Woods(no fire#yet)Hayward,WI � u oses in accordance with the Privac La��,s. 15 04(I)(m),Stats. 1. A lication Information-Please Print All Information Property O�vner's Namc Parcel# TB Investments 010133000300 Property Owner's Mailing Address Property Location 14346 W State Rd 77 c;o�t Lot�� City,State Zip Code Phone Number � � /a, /a, Section 36 Hayward, WI 54843 715-634-8176 41 os W T N; R II.Type of Building(check all that apply) Lot# X❑1 or 2 Family Dwelling-Number of Bedrooms 4 � Subdivision Name ,;,o�k# Hidden Woods ❑Public/Commereial-Describe Use ❑City of ❑State O�vned-Describe Use CSM Number ❑Village of 0 To��of Hayward IIL Type of Permit: (Check only one box on line A. Complete line B iTapplicable) A. ❑X New System ❑Replacement System ❑'I�reatment/Holding'l�ank Replacement Only ❑Other Modification to F.xisting System(explain) B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber List Previous Pennit Number and Date Issued ❑Permit Transfer to Ne�� Before Expiration O�timer ..--�— I�'.T - e of PO�VTS S �stem/Com onent/Devicr. Check all that a I� ❑X Non-Pressurized ln-Ground ❑Pressurized ln-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in of suitable soil �Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(eaplain) V. Uis ersal/Treatment Area Information: Design Flo�v(gpd) Design Soil Application Rate(gpds� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 600 .7 858 866 96 VL Tank Info Capacity in Total #of Manufacturcr Gallons Gallons Units � � o � u U � � � V New Tanks Eaisting Tanks � o a; � � � � � a. U v� � v� �[i C7 0. s��dc o�Holdins Tank 1250 1250 1 Wieser Concrete X Dosing Chamber �'I1.Responsibility Statement- I,the undersigned,assume sponsibility for stallation of the POW PS shonn on the attached plans. Plumber's Name(Yrint) Plumber's �onature MP/MPRS Number Rusiness Phone Number Travis Butterfield 652879 715-634-8176 Plumber's Address(Street,Cit}�,State,Zip Code) 14346W State Rd 77, Hayward WI 54843 VI[I. 'o nt /Dc artment Use Onl �A r� ed ❑ Disapproved Pennit Fee Date lssued Issuing Agent Signature $�W.�o ❑ Owiicr Given Keason for Denial �-��-01- � �� IX.Conditions of�ppro�al/Reasons for Disapproval � � i + �:��j� , ��1('i� ��J,— t � a � � pL � O� I - � '..j J��:{ U �7 Z�L� �� : � �; �_---- - Attach to complete pla r the system and submit to the County onl}�on paper not Iess than 8 I/2 x 11 inches i � �N�STRATVON c�3JiN�G ADM NO REFUNDS AFTER s��-��9s�Ro3�3� ��UE OF PERMtT 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 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 Owner Name(s): TB INVESTMENTS Phone: 715 _634 _8176 Owner Address: 14346W State Rd 77, Hayward WI Zip: 54843 Project Address: Lot 3 Hidden Woods Dr, Hayward, WI 54873 Govt. Lot: 1/4 of 1/4, Section 36 , T41 N-R 09 E ❑or W ❑✓ Township: Hayward County: Sawyer Project Parcel ID #: 57-010-2-41-09-36-5-15-239-000300 Designer Information Designer Name: TraviS Butterfield Phone: 715 _634 _8176 Designer Address: 14346W State Rd 77, Hayward WI Zip; 54843 E-17181�: OffIC2@bUtt2l�l@�C�C�rI��IIIg.COC71 I�his space rescr�•ed f��r approval stanlp. License Number: 652879 Remarks: Signature: Date: � -� �a� Ori al signature required on each submitted copy. �`l7 .�'NUP.S'I i"'en�f �a�.2 •2 0�' �j/ j�3�1� u� S�� Qd 7� �IP�-fio,�s (-{-�y wA�� , wT i'yb"(3 6v� -- �ao. o /1.,�l ,�� /� ` l3%.r-li l� /a� .p � o r� l 3 3 vc�o 3 cx� �ou� C6 /' 3 S P� 36 T �llrV ✓�. o q t,� a� �: D 3� 9g� � �oc,�n v� G-�y w� /o�S� �a ( G✓iPI-�/ Ca��re� �e••� y 3 qw:��. y �°�.S ��.6� �ps t ��1�- Sy�.,�,� �C. 96. o . .� � �--s`�.`a --` � u� (0D� � � P� ��`t'2� . 6,v'a',� y g�� w • �o a ��sb �"'�� L��- 3 06�,� o , � � � �� Je.,,� w�� ah,� � ��a v i S ��,� '{?�"e�� 5 ��sa �� 9 Septic Tank(s)Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA WIESER CONCRETE Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s): 3-ft Trench (down-sizing credit) 1250 gal gal gal gal Effluent Filter Manufacturer: BEST � GF10-8 Effluent Filter Model#: min.12" SOIL COVER (Typi�l) 12„ min.trench depth • �riP��> �� TYPICAL TRENCH � • . -' �� °�.a��. CROSS SECTION VIEW �— sa�� ` . �a, .. . (No Scale) ��YPIC21) '`a ^ ' a , a . � ° Provide minimum 3 ft System Elevation —96.0 � separation between trenches. (typical) Quick4 Standard-W w/End Cap Observation Pipe -�-yPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (rya��i) Install per manufacturer's PLAN VI EW instructions. �N O .SCB�@� � - - - - - - - - - - �f- - - - - - - - �� - - - - - - - - - — � � . � , ' � N. � I A= 3.Oft � ° (�YPicaq � � - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - -i D B = �72 ft -' rn (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typ�� 0 (mfd by InfiltratorSystems,Inc.) � Install pursuant to manufacturers instructions. 43 Quick4 Std-W @ 20 f� EISA/chamber= 860 ftz 'p + � Pairs of end caps @ 6 ft�EISA/pair= 6 ftZ = Proposed EISA per trench= 866 ftz Required Infiltration Area= $5$ ftz Distribution Method: x � trenches = Proposed Total EISA = 866 ftZ branched manifold � PAGE40F � r 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= 600 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 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. 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 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 ot individua� or company: gUTTERFIELD INC Phone: 7156348176 �oca� government unit: SAYWER COUNTY ZONING Phone: 7156348288 �ocal government unit address: 10610 MAIN ST. SUITE 49,HAYWARD,W1 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. Continqency 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. "' � PRIVATE ONSITE WASTE TREATMENT county ,;;t,;`—_;,�,�;�� i _,�,,r �-%oS '�;�� SYSTEMS Saw er �\��P�j� ( POWTS) Y NUfFsSltlriP�.-� INSPECTION REPORT sanitary Permit rvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� ^��" Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transactio�ID#� � :�,�v. Ka �-� -- Insp BM Elev: BM Description: Parcel Tax No: (��o' Q< << 6�� ot�- �33 -bo- a3�o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �� Benchmark �,p� Dosing Aeration Bldg. Sewer QS'l7' . Holding St/Ht Inlet 9`f,�,5� TANK SETBACK INFORMATION St I Ht Outlet q�{,$- ' TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet AIR INTAKE Septic -F�� N 6� ,�- � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. „2�-� Holding Dist. Pipe PUMP/SIPHON INFORMATION Infiltrative , Surface `�3.�5- Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W ,3 L 7 � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav 1� Conv ❑ Aggregate � P/L Bidg Well ❑ IGP Chamber Motlel Number: , INFORMATION Waters � AG � EZFIow CELL TO � � ` ❑ Mound o Other � —- -- ---- ---- _ DISTRIBUTION SYSTEM X Pressure Systems Only Header 1 Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes� Length Dia Length Dia Spac Spacing ❑Yes 0 No SOIL COVER — -- — - — -- Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center �Cell Edges � Topsoil _ _ � p Yes ❑ No � ❑Yes ❑ No� COMMENTS: (Inclutle code discrepancies, persons present,etc.) ��s�� (�� Plan revision required?� Yes❑ No � � � - � - �� /� � ! Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIDNAL COMMENTS AN� SKETCH SANITARY PEAMIT Nl1M8EA: �'02 -O YS— �I � , k� o �3� . �Y� , ; . . , �`T:B,B�.-�� c�.-�� @�M ♦ . _ . �►'►� . ; : _ : _ . _�__ ._ ._,_ �____:_ _ . _ _i -- � - - - --- - — _ _ � , ._ . ._ _ __ . _ __ _ _ ___, . ,o� � � : , ;_ � �. .... . -«.. . .. ... 4._. � . . .._ _ _. . :._... .. � �. �.. . � '� . �.._ _.� .r -i. . . . ' . �___.._.._ _" _ ." . � . . i � � ' �_ �. .. _� : ' ' 1 i �. 1 � , . '� : . . . ��. i ' ' . , �.. ... ...... . ...... � � � . . . � - \ : � � ��- r �6! � Y I�o � �{ �3�c. 9°`rn� �,��`? �- �o-� � �c a��"� �A1--- �� ,�wn��-s _— a- � � �► C�.