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Home My WebLink About026-939-14-5123-SAN-2022-093 %"�'^¢�``�� Industry Services lli��ision County � « �.:�..—-...,,,_ = 4822 Madison Yards Way SBwye� � - �� S� - Madison,W[53705 Sanitary Permit Number(to be filled in by C . : P.O.Box 7302 ��'��,�-��-- Madison,WI 53707 ��j� � � �� .vr.s�i��v�,�''2�, Sanl*a� PeY,mlt AppllCatl�n State Transactio�Number � l In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit � is required prior to obtaiiling a sanitary permit.Note:Application forms for statc-o��ned POWTS are submitted to Project Address(if different than mailing ac � the Department of Safety and Professional Services.Pcrsonal infonnation y�ou pro��ide may be u5ed for secondap . �� g�� t �� (1,} purposes in accordance��ith the Pri��ac}�La�c,s- 15.04(1)(m),Stats Y I.Application Information—Please Print All Information Property Owner's Name Parcel# Joseph & Diane Young 026-939-14-5123 Property Owner's Mailine Address Property Loeation 11525 Palisade CT NE Govt Lot � City,State Zip Code Phone Number Blaine, MN 55449 %- '%, se0r�°n 14 II.Type of l3uilding(check all that appl��) ��t# l 39 N R 09 �[or W �l or2 Pamily D��clline- NumbcrotBcdrooms.4_ � SubdivisionName Block# ❑Public/Commercial—Describe Use �City of _ �State Owned—Describe Use CSM Number �Village of 4�� Q�� <,r Sand Lake U 1[l.Type of POWTS Permit: (Check either"New"or"ReplacemenP'and other applicable on line A. Check one box on line l3.Complete line C if a licable.) `�� Ne��Systein �Re lacement System �Other Modification ro Existina S stem e� lain �Additional Pretreatment Unit ex lam) ✓ P o�Y� � p ) � p• �' �Holding Tank �In-Ground �At-Grade �Mound �Individual Site Design Other Type(explain) (conventional) ��• ❑Rene�a�al Before �Re��ision �Chan�c of Plumbcr �I�ransler to New Owncr�'�st Pre��ious Permit humber and Date Issued Expiration IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Desi�n Soil Application Rate(epd/st) Dispersal Area Required(st) Dispersal Are�a Proposed(s� System Elevation 600 0.5 1200 1212 93.00 ' Capacity in Total #of Manufacturer Tank[nformation Gallons Gallons Units � L o � � New Ta�ks Esisting"I�anks '� c � � � � � � 2 U �:% s ;n :s. C: � s�Pc��rtota�n�Ta�k 1250 1250 1 Wieser Concrete ✓ � Dosing Chainber � � � . V.Responsibility Statement- I,the undersigoed,assum espo ibi ty or installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb ;.ignah e MP/h1PRS Number E3usiness Phone Nwnber Travis Butterfield 652879 715-634-8176 Plumber's Address(Street,City,State,Zip Code) 14346W St. Rd. 77, Hayward, WI 54843 VL County/Department Use Only � o�ed ❑ Disapproved Permit Fec Date Issued Issuina Aeent'Sienature �� $ .o �/ ,, �,�� ❑O�vner Given Reason for Denial �� l.Y�� "� ��'��"�`'��'� Conditions of Approval/Reasons for Disapproval � [1 C�: �� i� � �� C-ST ��— OCQ�i JUPJ 0 2 202Z ��v`:�� s,�� c��s:::;;�:,n.. Z�i�1��UC:3 fi'�-_:�vRi\.i�"..'.r,' �,'�'t4,i:J Attach to complete plans Tor fhe s}�stem and submit to the Counh�only on paper not less than 8 U2 s 11 inches in sizc NO REFUNDS AFTEp sB�-b�9s�R.o2iaz� ISSUE O�'PEAMIT 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): Joseph & Diane Young Phone: - - Owner Address: 11525 Palisade CT NE, BLaine, MN _ Z;p: 55449 Project Address: 6177N Breezy Point Ln, Stone Lake, WI 54876 Govt. Lot: � 1/4 of 1/4, Section �4 , T39 N-R 09 E❑or W ❑✓ Township: Sand Lake County: Sawyer Project Parcel ID #: 026-939-14-5123 Designer Information Designer Name: TravlS Butterfleld Phone: 715 _634 _8176 Designer Address: 14346W St. Rd. 77, Hayward, WI _ Zip: 54843 E-mai�: office@butterfielddrilling.com �,�i,;s;��e,-t,�r,�zaro,��,��,��,��,i �r�,,,,�. License Number: 652879 Remarks: Signature: Date: � w� � �� Ori inal signature required on each submitted copy. o� a °� � � � � �� y°�`� ° N �Q �Oa,�! SA� � ��( JlsaS � 13��.�� t�v s�s�Y9 �5� . ,a 3 � r „Z So, � ��6- 93�-iy_ � J�d� ,�,� �...k�- � �.o �� S g�,- � 4 � Pl.^t o� T w-� �R o � c,� �a � ;� l G , �� Y ��`�� - �� % �� 9�� Qb� � 8� Y,,� `� (3S� "-'�/ . 31 gs•�s �CS - �� 5�� , /� ;5� � ��" �� P�� . (,� / ,,� �s-. Ca� � p,N. . � �� ' �,�0 ; �g �' o�f � � -� a� 3� �o � ` , � , �� ti � `LL � � �) � � l ' /� (,J'e5� w�� nl` � (a� �� .��s ��,,,S � ' � �o Q,,�:�� `� ' � QSfi �� ra��s t3,,cf-�e�l�'-P(�1 �PKg .� 6 sa 8'�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 � Erri�e�t F�ite�Moaei#: GF10-8 min.12" SOIL COVER (rypical) 12" min.trench depth • c�vP��an ��. � TYPICAL TRENCH - - •— —. - -� � �� °�.a �•. CROSS SECTION VIEW �YP��a�� :�,� �°� � � . . (No Scale) � a• ' a . •' Provide minimum 3 ft System Elevation —93.00 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap ObservationPipe TYPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (typical) Install per manufacturer's PLAN VI EW instructions. �NO SCa�@� � - - - - - - - - - - -�f- - - - - - - - �� - - - - - � I �A= 3.0 ft , �tYPical) � � - - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - -J D � a = �2o ft - � m (rypical) Quick4 Standard-W Chamber W (typical) O INSTALL PER TRENCH: (mfd by��f�t�ato�system5,��o.) � Install pursuant to manufacturers instructions. � 30 Quick4 Std-W @ 20 f� EISA/chamber= 600 ftz + � Pairs of end caps @ 6 ft�EISA/pair= 6 ftz = Proposed EISA per trench = 606 ft2 Required Infiltration Area= 1200 ftz Distribution Method: x 2 trenches = Proposed Total EISA = �2�2 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= 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 of individual or company: BUtt2�'�FIG'ICI, ItIC. Phone: 715-634-8176 Local government unit: SBWy@C' COUnty Z011ing Phone: 715-634-8228 �oca� government unit address: 10610 Main 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. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Officc of Sawye�- County Zoning and � Conservation Administration �l ��n� � / .� 10610 Main Street, Suite 49 �7 ��/�� Ha ward WI 54843 Jq \\�..� Tel:(715)634-8288 S,� � �y �OZ3 �f� Fa�c:(715)C>38-3277 ZpN� wy�. UItT,:http://sa�vvercounn� oQ v'or7 NGqoA Cp� Email:zoi�in�.sec��sa��}�ercot�i�ty o�v.org �fN�ST�� 1'0ll Free:Courthouse/General Information � 1-877-699-4ll0 Sawyer County Zoning and S�tiitation "As - Built" Form � > J o S e,p� -�- U i q� e �o u vi Property Owner s Name J Fu�e Number and Road Name � �/ , � � ��e 2% ��,� G� Plumber's Name ��`-✓r j /'?''`.��.�'.�(� Date of Installation �� County Sanitary Peimit Number aa - � �3 12 Digit Parcel Number �b�� - 9�3� - /y - sia3 Description and Elevatio�i of Benchmark �a�� al � r'n P,n e ��p_a Tank Manufacturer and Capacity �-✓ ' ��'e� �� Setback-Tanlc to Nearest Lot Line 3� � � Setback-Tank to Nearest Well � Setback-Tank to Building �� ___ _ Cell Width 3 r � ---i � --- Cell Length `I�� a Y y � � N�unber of Cells Setback-Cell to Nearest Lot Line �S /d� i Setbacic-Cell to Nearest Well � i Setback-Cell to Building �� ____ Setback-Cell to Navigable Water �� Make and Model of Dispersal Unit _ �"'�G� C/ r/��___ Make and Model of Filter ��S� �� — � Make and Model of Pump - Please complete othet• side - 66As-Built Plot Plan" Elevation Data i � Benchmarlc � �o Please include the followin�: Building Sewer � �Y� Tanlc In 8`� • Location of observation and vent pipes Tanlc Out S� 7 • Feet of risers used on tai�lc(s) Dose Tanlc In • Location of benchmarlc and Noi-th arro�� Dose Tai�lc Bottom — � Location of all coinponents Header or Manifold � � " • Length of pipe between components - Distribution Pipe -- • Number of chamber units in each cell System Elevation �o,o • Location of well, lot lines and road � � —_ lv ;' � �u� , ��_� � ,! / .` � / � �. : �� ,, 0 , a� ��„s�� N � a -(a,._ o �'E�� , r /O —ISC�ywl•�J � �� v ��.� , / ��f 7` � V a Q � v