HomeMy WebLinkAbout010-841-14-5129-SAN-2022-103 �,,-���°'"""�� Department o€Safetv c°°°ty �
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�:�; � �-� & Professional Services,
js` � � j.� Sanitary Permit Number(to be filled in by Co
� � �� � ; Industry Services Division
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Sa111taIy peT�1111t AppllCat1011 State Transaction Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � d
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing add� �j
the DepaRment of Safety and Professional Services.Personal information you provide may be used for secondary t Z�3�W W 1 r, � 'n �
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � pxC.��O I'}�l
I.Application Information-Please Print All Information
PropeRy OIwner's Name Parcel#
W� �cXwo�a� L-vc� e �oc. �^ '. CeCe Genri�l, ola8� l tyslol
Property Owner's Mailing Address Propertyt ocation
47 � � �1 (-�as k',�.s R�' Go�`io��
City,State Zip Code Phone Number
/.�a WQ�, fi ' � � �C�y3 �i )f, Section 1�
( 1 G�
II.Type of Building(check all that apply) Lot# T�N R b8 E o
fL�1 or 2 Family Dwelling-Number ofBedrooms___�._ _ Subdivision Name
Block#
❑Public/Commercial-Describe Use
� ❑City of
❑State Owned-Describe Use CSM Number ❑Village of
� J$Town of ��TC�tiwC.r�
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
`4 .�Re lacement S stem
❑ New'System p y ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank In-Ground ❑ At-Grade
� ❑ Mound � ❑ Indicidual Site Design ❑ Othet Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued
Expiration ��-�Y(� � S ',Z7 8
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(s� Dispersal Are;�Proposed(sfl System F,levation
3�O o . "�1 `-/�g-(o �/s� �9 . �
Capaciry in Total #of Manufacturer
::
Tank Information Gallons Gallons Units � V U '$ N �
New Tanks Existing Tanks L o a; � v � � �
a U v� ti �n ii C7 ci
Septic or Holding Tank f�S-� I�S� I �'� � /' NCr, t
/ i l�0
Dus'ing Chamber
V.ResponsibilitV Statement-I,the undersigned,ass responsibility for installation of the POWTS shoHn on the attached plans.
Plu er's Name(Print) Plum er's ignatur MP/vIPRS Number Business Phone Number
� !as ��c���l�e 230�2� �/S-?3�-�8��
Plumber's ress(Street,City,State,Z Code)
Pd � l�'(� r� v�vvt a�� (..�.5 �/ 3 '
VI.County/Department Use Only
9 Permit Fee Date(ssued Issuing Agent Signature
�A pr ve ❑ Disappro�ed
� ❑Owner Given Reason for Denial $��,°o �� �� � �'' ��'I'���-'-����"�
Conditions of Approval/Reasons for Disapproval J y r., 4�;-,�—`•-�,_.y.,,
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SRdVYER COUNTY
ZOIVlt�AUMINISTRATION
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398(R.03/22) N�REFUNDS AFTER
ISSUE OF PERMIT
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2 , � ( YY1aY ��7.� - ,�0��1� � � � � ��
�'Y. _ Crrccrw•d soi 1 14b6orP�1o�• �v►+�oh¢ "•�'` ,r Z`s
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
Tank Specifications POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Wildwood Lodge
Owner Name(s): Wildwood Lodge Association Attn: CeCe Genrich phOne: - -
Owner Address: 9728N Haskins Rd Hayward, WI _ Zip; 54843
Project Address: 12733W Wildwood Ave
Govt. Lot: � 1/4 of 1/4, Section � 4 , T 41 N-R �$ E ❑ or W ✓❑
Township: Hayward County: Sawyer
Project Parcel ID #: 010841145101
Designer Information
Designer Name: Douglas Manthey Phone: 715 _ 739 _6868
Designer Address: PO Box 196 Drummond, WI � Zip; 54832
E-rpal�: IIOfpIf12S U�Ch@C�n2t.112t This space reserved for appro�r�L stainp.
License Number: MP230722
Remarks:
Signature: '� �-� $ Date: 06/02/22
Origi I signature require ch submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s) Manufacturer:
Wieser Concrete
Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s) Volume(s):
3-ft Trench (down-sizing credit) �50
gal gal gal gal
Effluent Filter Manufacturer:
. Orenco
I min. 12" Effluent Filter Model #: � 4B
Geotextile I (typical)
Cover
SOILCOVER TYPICAL TRENCH
'Z� � CROSS SECTION VIEW
min. trench � s •
depth ' �
c�P���> �- — — —� , -� ;.. �: :.; � (No Scale)
OBSERVATION PIPE DETAIL
� . • •' •. ; ' (No Scale)
89.7 y� .� � ' Screw-Type or •
System Elevation = ft. '� �' : si�P caP �ioose� �. '�'���r• Finished Grade
(typical) Provide minimum 3 ft , , (mulched& seeded)
separation between trenches. a"0 PVC Pipe ' ` �;;.� Topsoil Cover
Top of pipe to terminate �'� '•,` (min. 1 foot)
atorabovefinishedgrade • .� � '
(4) 1/4"-1/2" X 6"Slots
TYPI CAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) @ s•o apart ,,:; ,
.�, ;�
PLAN VIEW AnchoringDevice • '" �'�"' � ISurfat�n
4�� � Observation pipe shall be installed
(No Scale) atjundionbetweentwounits. 5 ft
Perforated Lateral Observation Pipe
(typical) (typical) (typical)
— — — — �i� — — — — — — — — — — — — — — — — — — —
r - - - - - - - - - - �
I =_____ _______ _-___ __ ___ _______ _______= I A = 3.0 ft �
- - - - - - - - �� — - - - - - � �tYPical)
� - - - - - - - - - - - - - - - - - - - - rn
B = 45 ft -=i C,,�
(typical) O
INSTALL PER TRENCH: EZ1203H Bundle -n
(typical) �
4 10-ft bundles @ 50 fiz EISA/unit — 200 ft2 (mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturer's instructions.
+ � 5-ft bundles @ 25 f� EISA/unit = 25 ftz
= Proposed EISA per trench = 225 ftZ Required Infiltration Area = 42$•6 ft2 Distribution Method:
x 2 trenches = Proposed Total EISA = 450 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= 300 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: NOP PIII@S PIUCTII�ICIg Phone: 715-T3J-6H6H
Local government unit: SaWy@f COUI'lt�/Z011lllg Phone: 7�5-634-H2HH
�ooa�9o�e�nme�t�nit add�ess: 10610 Ma111 St Ste 49 Hayward, W I Z�P: 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.
Contingencv 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.
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T' Z SEPTIC MANUAL ,N3716 US hWY 10, MAIDEN ROCK, W 54750 CATE: 00/CO/00 POST-POUR:
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�--' '`T�� PRIVATE ONSITE WASTE TREATMENT county
�2?�t,{µ +/` �\�� SYSTEMS
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"��� ( POWTS) Sawyer
s -,
��Fr,s,io.�;,,,��,•.
INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION v�2 — I��
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
W'l��"'Do6���S.r2,1'15.�.. � �.�/a�A �
Insp BM Elev: BM Description: Parcel Tax No:
��� '° � /t/� cor►�es-o'�' c��� � a�c's��� �lo --�Y(— �(�S'I o 1
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,"���- —� Benchmark too.o`
Dosing
Aeration Bldg. Sewer QY,�'
Holding St/Ht Inlet 9�.3'
TANK SETBACK INFORMATION St I Ht Outlet 4 2,o'
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic ,y��` � � � ,}..� � NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header l Man. 10,( '
Holding Dist. Pipe
PUMP/51PHON INFORMATION Infiltrative
Surface $ �
Ma�ufacturer Demantl Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Heatl TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS �N 3� L t,fS �(s #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters °� GP ❑ Chamber Model Number:
� EZFIow
CELLTO '?"(oo � .f-��� �� ❑ Mound � Other
-_�� —`�--- -- — _
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold 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 Seetled/Sodded Mulched
Cell Center TCell Edges Topsoil_ ___ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
����(� �(��(��
Plan revision required?❑Yes ❑ No � c� '/ �
o �-3 23 �_ �.. _ _ � Sb �a
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: �-�r- I��___
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