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Home My WebLink About012-740-04-5116-SAN-2022-071 - C 0.1l �Y ' � ,�i- _—— /o�t'""'"'�� Industry Services Division County � �/�/��I '�K} 4822 Madison Yards Way S � �x'� �' 1�� Madiso WI 53705 �sl �=r- � � � Sanitary Permit Number(t be filled in by Co. S �f'� �� />>� P.O.Box 7162 L �"��:"� � Madison,WI 53707-7162 (�3�l t7�y `�M' N Sanitary Permit Application StateTransactionNumber �, In accordance with SPS 383.21(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 Project Address(if different than mailing addr� Q' the Department of Safety and Professional Services.Personal information you ptovide may be used for secondary � purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. 9 S�y N CO�f'1 C O f �� I.Application Information-Piease Print All Information � Property Owner's Name Parcel# e;d � � r,n S �� c c�� a-�yo - oy s�� cA Property Owner's Maiting Address Property Location (s'i �'.d+e.c v�tw G� co�c.�oc I City,State Zip Code Phone Number S e f E=e�s o c,. w Z J'r 3 5 y 9 '/., '/<, Section d y Q.Type of Buitding(check all that apply) Lot# T�N R O'7 Fse �1 or 2 Family Dwelling-Number ofBedrooms J o1 Subdivision Name Block# ❑Public/Commercial-L)escribe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of csr► ,r� S�78 �o�,,,,af N�rn�r�cr vo�.35 •1�o► IIL Type of POWTS Permit:{Check either"New"or"Replacement"and uther applicabie on line A. C6eck one bog on iine B.Complete line C if a licable. `4� ew S stetn � Re lacement S stem Other Modification to Existin S stem ex lain �1 y p y g y ( p ) 0 Additional Pretreatrnent Unit(eatplain) B' � Holding Tank �Tn-Ground � At-Grade gn ype( �cp ) � Mound � Individual Site Desi 0 Other T e lain conventiaial) C• � Renewal Before Revision � Change of Plumber � Transfer to New Owner �st Previous Permit Number and Date Issued Expiration IV.DispersaUTreatment Area and Tank Informationc G1 u i G K I u M w / S Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(sfl Dispersal Area Proposed(s� System Elevation 300 o.s �oo G�a ,rr 90 .00 Capacity in Totai #of Manufacturer Tank Information Gallons Gallons Units � J � � � y � New Tanks Existing Tanks � a " �' � p � � a U Tn � v� i:. C7 a, Sepdc or Holding Tank �s O ,�, r'S� ( l�► c' X Dosing Chamber V.Responsibility Statement-I,t6e undersigced,assame respon�ibility for installation of t6e POW1'S showo on th�athched pians. Plumber's Name(Print) Plumber's � re MP/MPRS Number Business Phone Number �jtra.�c! �'�eerne 1 �� 950�11 7�5-53'8- 1138 Plumber's Address(Street,City,State,Zip Code) �3 s o a w F ro e.�e 1 iZd �� wc,,i-a w.r s�B y3 vi.co o� �rm�oc o�oo�y �A�d ❑Disapproved P�t Fee Date Issued Issuing Agent Signature ❑Owner Given Reason for Denial �� S i�Z�22 �,��_"""""'� Conditions of ApprovaUReasons for Disapproval �� ,ST 22 - dS I� D � �� MAY 1 1 2022 Attac6 to wmplete plans for the system aad submit to t6e County only oo pa r n ess than S v2 x 11 inches ie siz��NG ADMINISTRATION NO REfUNDS A�1'�� sBv-�39s�.o3i2i> ISSUE OF PERMIT 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 Stuckey - Concor Rd Owner Name(s): Heidilynn S Stuckey Phone: - - Owner Address: 643 Riverview Ct ; Jefferson, WI ZiP; 53549 Project Address: 9594N Concor Rd Govt Lot: � 1/4 of 1/4, Section 04 , T 40 N-R �7 E❑or W�✓ Township: Hunter County: Sawyer Project Parcel ID#: 012-740-04 5116 Designer Information Designer Name: Gerald Froemel Phone: 715 _558 _1138 Designer Address: 13502W Froemel Rd ; Hayward, WI Z�P; 54843 . E-mail: Jayfroemel@gmail.COCYI This space reserved for approval stamp. � License Number: 950111 Remarks: Signature: � Date: `��`—z z Original signature required on each submitted copy. SCP► �� - t : y0 P�,C�T- I�LR N e i0 YO 40 80 �t59'�N Gon tc r �d 1�/OEieu3Ld 1, Stc. �4,TyON�Ro7W 'Tt��ani oF M�n�reR� SAWyERcooNTY Pat. o►�-7yo-t��l 5�1 (. c.e� , csr, M aa7's, .ro►.ss�p.�vl � c � � �, ti"P�rG sci►y0 ;, � d, a�� Ai7M f�9 I �p_ DR•v��Ry y J � r- -- -r I � � �`-0A''c � � B3 �d � . .a � �j.:s�� 8� �Pr R � � ` � � � _J , P w� � 6� r'J 1 - 7„g�Q a 1. ,p re,.� Oe+�C K�G S iPG�4n K �'►'+4d� �pY w.e�e� Ce�nc�e+e wr 4;�t�.r►a �r�/a�% liec- AA � AbBo�p?�vr, A�ea con4�5'►c*a� b4 +we eellb, Sp«oed ='3 fP opetr�� cor.�c.lnins �a. �eta) o�C 3o p�:ca.y i°lvg GMan►b�r1 � ��`��j—O�/I -- i�� a o� �1 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) 75o gal 9a� gal ge� Effluent Filter Manufacturer. Lifetime Filter LLC � 1 Effluent Filter Model#: LT-1/8 min.12" SOIL COVER (tyA��l> 12» min.trench depth • caa��n �� • � TYPICAL TRENCH � • . -� � �� '�.a� �-. CROSS SECTION VIEW �- �`� � � �� (No Scale) �tYp�4 ':', . . . .r . a,. . :. . ' Provide minimum 3 ft System Elevation = 90.00 � separation between trenches. (typical) Quick4 Standard-W wI End Cap Observatlon Plpe TyPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (�vP��) Instalf per manufacturers PLAN VIEW �nsc`��t�'S. (No Scale) � - - - - - - - - - - �� - - - - - - - ��- - - - - - - - - - — � j A= 3.Oft L - - - - - - - - - lhPical) � - - -�� - - - - - - - �j` - - - - - - - - - -� G� B = 63 ft -' m �ryP�� Quick4 Standard-W Chamber W INSTALL PER TRENCH: �typ�� (mfd by Inffltrator Systems,Inc.) � InstaN pursuant to manufacturers instructions. � �= Quick4 Std-W @ 20 ftz EISA/chamber= 300 {�2 + � Pairs of end caps @ 6 ft�EISA/pair= = ft2 = Proposed EISA per trench= 306 {{z Required Infiltration Area= 600 {�2 Distribution Method: x 2 trenches = Proposed Totat EISA = 612 �Z 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 Disqersal Area Operatin� Limits: Design Flow= 300 9Pd; BODS<_220 mgL"'; TSS <_ 150 mgL''; FOG 5 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e. odors, user complaints, efc.) 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 manufacturePs 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: Gefald FPO@171@I Phone: 715-558-1138 �ocai go�er�me�t u��t: Sawyer County Zoning & Conservation PhQne: 715-634-8288 �oca� government unit address: 10610 Mai� St, Suite 49 ; 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 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. 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