HomeMy WebLinkAbout010-277-00-2500-SAN-2022-061 _ ` Industry Services Division County �
� 4R22 Madison Yards Way Sawyer >
� Madison,WI 53705 `
_' = Sanitary Permit Number(to be filled in t
= P.O.Box 7302
- , Madison,WI 53707 ��� � �� _ N
Sanitary Permit Application State Trnnsaction Number �
Iu accordancc with SPS 3R3.21(2),Wis.Adm.Codc,submission of this form ro thc appropriatc govcmmcntal unit � CJ
is required prior ro obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submined to Project Address(ifdifferent than mailin� �
the Department of Satety and Professional Services.Personal information you provide may be used for secondary �
putposes in accordance with the Privacy Laµ,s. ISA4(I)(m),Sta[s. —
I.Application Information-Please Print All Information
Property O�sner's Name (�(!�1�� ,.� ' Parcel# �'�►j., �7'� -Q�.� 25�.�
Seth Hahn Y ���,`w LZ 57-010-2-41-08-19-5-15-277-02500
Property Owner's Mailing Address Property Location
3105 W Sprucleigh Ln � o�.
City,State 7_ip Code Phone Number
Sioux Falls SD 57105 _ , Scction 19
11.Type of Building(check all that apply) Loc# T41 N R 8 E o W
�1 or 2 Family Dwclling-Number ofBedrooms 3 25 Subdivision Name
B,o�k# Hatchery Creek 5.,,�.
�ublic/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number illagc of
�ToW„of Hayward
I11.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.
✓�Iew System �2eplacement System ther 4fodification to Existing System(explain) ❑Additional Pretreatment Unit(explaui)
lJ
B' ❑Holding Tank In-Cttound �At-Grade �Mound Individual Site Design Other Type(explain)
�(conventional)
C• Renewal Before �Revision 'hange of Plumber �Transfer to New Owner
List Previous Permit Number and Uate Issued
Expiration �-�—
IV.Dispersal/Treatment Area and Tank information:
Design Flow(gpd) Design Soil Application Rate(gpcUs�) Dispersal Area Rcy��ired(sf) Dispersal Area Proposed(s� System E vation �
450 .7 642 652 � � _
Capaciry in I�otal #of Manufacturer
�
Gallons Galloos Units w o 'a �
Tank lnformation � y;
New Tanks Existing 7'anks � o °�'� 2 � D `° C°
a U in h v� ii C7 Ci.
Scptic or Holding Tank 1000 1000 1 Wieser ✓
Dosing Chamber � � �
V.Responsibility Statement- 1,the undersigned,assume r ponsibi'ty for installation of the POWTS shown on the attached plans.
Plumbcr's Name(Print) Plumber's Si atu � MP/MPRS Number Business Phone Vumber
Dan Burch / 253808 715.416.1642
Plumber's Address(Street,City,State,Zip Code)
N5921 County Hwy K Spooner WI 54801
Vt.C un /Department Use Only
� pro d ❑Disapproved Perniit Fee Date Issued Issuing Agen[Signaturc
❑Owner Given Reason for Denial $ l w'�� �I Z `� � �� �'�'G�-(,�.c.k'�.��'�'��'
Condition�Approval/Reasons for Disapproval
° �� ����4������ c
�� � �� APR 2 8 Z ��`
L 0
�---- 22 J
SAWYtR CC�.�",�-;�-�:
ZO � .
Attach ro complete plans for the system and submit to the Couuty only on paper not less than N vi z t I inches in size
S$D-639R(R.02/22) ( j J '�' �' {
` �� 2 2- L � � / NO REfUNDS AFTER
iSSUE OF PERMIT
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design Refe�nces: -
Version 2.0, SBD-10705-P (N.01/01, R. 10112). , ,
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section 8� Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Ap lication for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): � �"�� ���N�/ Phor�e• - -
Owner Addness: � (:��' � �5 P�l,��� ��� �/� L �S���ip: 5 7�� `�
Project Address: �C,�c�-c,-� � �"�c K
Govt. Lot: 1/4 of 1/4, Section , T N-R E Q or W❑
Township: 1-�h J�/?2+� County: S���E�L
Project Parcel ID#: .5 7 �� � � y I �� �`t S 1 S � 7� ,�,� SJ�
Designer Information
Designer Name: Dan Burch Phone: 715 _416 _1642
Designer Address: N5921 Cty Hwy K Spooner W1 Z,p; 54801
E-111a11• Burchplumbinginc@gmail.00111 This space reserl•ed for approva!stamp.
License Number: 253808
� ��-;,
Remarks: � �����Jj '` '�
- ____.�.
APR 2 8 2022 ;��"�.
S�IWYER COiJt�;-;y �
ZON�1fVCi ADMINISTRA7ruiV
Signature: Date: `� - �� �� �
Origin signature iequired on each submitted copy.
Seth Hahn
Soi[Report Plot Pian
NOrth Certierlineof8trkenTrailRd ----- --r'�'"_-----�--------___,...------ ``^
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5eth Hahn +`
t
####Birken Trail Rd � . '
Lot�5 Hatchery Creek Subd $
S19 T41N R8W �..
Town of Hayward
PIN:57-�10-2-Q1:-Q8-19-515-277-�02� ' b�
2.44 Acres
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1 1 �-f � Pro 3 bedroom
�J l`�3�ja dweli;ng
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� Bench Mark=Nai!w/'arange rtbbon in 28" DBH whfte pine tree
Elev=100.0' !VO'r�S:
Scate 1:40 -�a we11
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Page 3 of 3
IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manufacturer:
wieser
Stepped Elevation Trenches with Quick4 Standard-W Chambers
Septic Tank(s)Volume(s):
� 3-ft Trench (down-sizing credit) �000
gal gal gal gal
Effluent Filter Manufacturer:
� Polvlok
SOIL COVER
min.12"
�rypi`'��� Effluent Filter Model#: 525
12"
min.trench
TYPICAL TRENCH depth •
CROSS SECTION VIEW �`�'�'' � .
- - '�'� Provide minimum 3 ft
(No Scale) � � � � � � �°. '°
r �"�-----I <' separation between trenches.
(tYPical) • , . .
'a a,. . �
w . a a
Hignest Trench Lowest Trench (as applicable)
System Elevations= 88 ft; 86 ft; ft; ft; ft
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) ttvP���)
Install per manufacturers PLAN VIEW
instructions.
(No Scale)
�- — — , - - - - - -��- - - - - - - - -��- - - - - .— x �� - -�
` , ;�� '�` � .i��� , �� ,: f,r�� , ,, �A= 3.0 ft
~ � ""�'� � �� +� ' b~ (typical) �
— ,.
� - - - - k - - - - - - - �� - - - - - - - ��- - - - - - - - --� D
�- B = 64 ft _ ' m
(typical) Quick4 Standard-W Chamber CrJ
INSTALL PER TRENCH: �typ���� O
(mfd by Infiltrator Systems,Inc.) —n
Install pursuant to manufacturers instructions.
16 Quick4 Std-W @ 20 ft�EISA/chamber= 320 ftZ �
+ � Pairs of end caps @ 6 ftZ EISA/pair= 6 ft2
= Proposed EISA per trench = 326 ftz Required Infiltration Area= 642 ftz Distribution Method:
x 2 trenches = Proposed Total EISA = 652 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= �'/ �� 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(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: DaCI BUfCII Phone: 715.416.1642
�ocal government unit: SaWy2r COUnty Z011111g Phone: 715.634.8288
�oca1 government unit address: 1061 O M8111 St. #49 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 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.