The URL can be used to link to this page

Home My WebLink About010-941-21-1305-SAN-2022-110 �ri � �.4 1l!� � %�''-'=�:�\ Industry Services Di��ision County „i �' � 4822 Madison Yards Way Sewye� i�,"-��ti�a� '-.' Madison,WI 53705 Sanitary Permit Number(to be filled in by Co. � � r , S . P.O.Qox 7302 � ';�;�--� Madison,WI53707 �S3 �3r� � � � �_�.,,-.: � Sanitary Permit Application State T�ansaction Nii_mber � In accordance with SPS 38321(2)_Wis.Adm.Code,submission ofthis fonn ro the appropriate govemmental unit � is requircd prior to obtaining a sanitary pennit.Note_Application torms for state-owned POWTS are submitted to Project Address(if different than mailing addr the Department of Safety and Professional Services-Personal information you provide may be used for secondary purposes in accordance with thc Privacy Law,s. 15.04(I)(m),Stats. 1� It I.Application Information-Please Print All Information � �A�l10 t'�.I` � , Property Owner's Name Paroel# .�� ,. KIRKEGAARD REV TRUST 010-941�1-1305 Property O�cner's Mailine Address Yropert} I.ocation 4795 COPPER CIR ``�' <;�.�-�,. City,Statc Z.ip Codc Phone Number WOODBURY, MN 55129 S�"� %, N� '%, se�"�n �' [L Type of Building(check all that apply) Lot# -�41 N R 09 E or W �I or2 FamilyD�cclline-Numberof[3cdrooms 3 3 Subdivision Name Block# �' �Public/Commercial-Describe Use ❑City of - __ �State Owned-Describe Use CSM Number �Village of 37�69 � (..)533 ❑✓ To""of Hayward _ III.Typc of POWTS Permit: (Check either"New"or"Replacement"and other applicable on line A. Check one bo�on line B.Complcte line C if a licable.) `�� New S stem �Re lacemcnt S�titem �Other Modi tication to Existin>S stem ex lain �Additional Pretreatment Unit ex lain) ✓ Y P )'� ��Y � P ) � P B' �Holding"I�ank �In-Ground �1t-Gradc �Mound �Individual Site Design Other Type(eaplain) (conventional) C. �Rene�cal I3efore �Re�°ision �Chanee of Ylumber �Cransfer to Ne�c O��ner��ist Prerious Yermit Number and Date Issucd Fxpiration IV.Dispersal!"I'reatment Area and Tank Information: Design�lo�c(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(sf) Dispersal Area Proposed(s� S}�stem Elevation 450 0.7 643 652 97.00 Capaciry in Total #of Manufacturer Tank Information Gallons Gallons Units � � U -O � New Tanks Esisting Tanks '� c a� ` Y � �y � 0 a. U v� � v� u. C7 a Septic or Holding Tank �p�� 00� 1 Wieser Concrete � � Dosi�g Chambcr � � � V.Responsibility Statement- 1,the undersigned,assu sponsibility fo i tallation of the POW'CS shown on thc attached plans. Plumber's Name(Print) Plumbe s ignature MP/�iPRS Number f3usincss Phone Number Travis Butterfield 652879 715-634-8176 Plumber s Address(Street Cit�.State.7ip Code) 14346W St. Rd. 77, Hayward, WI 54843 VI.C un y/Department l!se Only �Ap � ❑Disapproved Pennit Fee Date Issued Issuing Agent�ignaturc ❑O��mer Given Reason for Denial $ ��'� � �� `� ��'�`"""'�"��"��`� _--�,--�,- � Conditions of Approval/Reasons for Disapproval � ` .,�., , � 1 ; � .; �� i�-_J� �'�� r`. � C�i% �� S�- � l — O-�� JUN 1 4 2022 � T SAWYER C�U^J,Y ZpN►NG ADMtNlSl'RAT10�! Attach to cumplete plans for the system and submit to the Counh'only on paper nof Iess than N U2 s 11 inches in size ss�-63�s�R.ozi22� NO REFUNDS AFTER 1SSUE OF PE�MIT PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version �(, SBD-10705-P (N .01 /01 , R. 10/12) • � � a , 1 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) : KIRKEGAARD REV TRUST Phone: - - OwnerAddress: 4795 COPPER CIR, WOODBURY, MN Zip; 55129 Project Address : LOT # 3 RADIO HILL Govt. Lot: PRT SW � 1 /4 of NE � 1 /4, Section21 , T41 N-R09 E ❑ or W ✓❑ Township: HAYWARD County: SAWYER Project Parcel ID #: 010-941 -21 - 1305 Designer Information Designer Name : Trevis ButterField Phone : 715 _ 634 _8176 Designer Address : 14346W St. Rd . 77 , Hayward , WI Z�p; 54843 E-mai�: office@butterfielddrilling .com �r�� s��d� e � eset��a r�� ;�� t>,�� 5r��,�p. License Number: 652879 Remarks : Signature : Date: � -� y ' a � ginal signature required on each submitted copy. �a. e 2 0� �- . � , Ow e�` = L� ��fFL QGIGIIrP �/u•f 1 S��"�,2r l.o-� ,ia`�u�cor� T��- ! � �� ►� o�o --�4t- zt-- l305 `17 g� �� Cc`r� s w/N e s' z � --r- t-+c n1 1� �� o n�l��7 � rh rt1 Ss�a 9 L o-�- 3 G'S M 3��6� � 85 33 s•,{�: t�d�'D I-�,-(( fz -�t fi C�ot� �.o��s e� � -- =_�_ _ �/� �.�� - � �� U Sc�e [°� 3a' . o lo' Zo' 3c, � � i --— / � / \ 3 B�'"`` � . - �, G� ��`� do 0 � , ; � ° o!� _ ��o � G.�[ v .� L � 2. � • 6�[�a� 1 (�0.d,� 1-�-�.�ll 2d . � Inc�� a� home�r��-0.��. �-!'Prox�►v,4��e 1► B�t�ao f ioP o-� P��. t'�� SECvrn�r � �e�t -�o v��- Cod� s-ei-b4�ks �I, lDa' „�' Z, !a0-��, �oo� �a� G✓i cgv� C.�✓�c 3. jo�.!` 3� C�k,G14 �( �/4S c�.�,b�' .�[ So',js� s�s�e(. �3�I.5' �s fi �r��e/I C r�ge� asZs' _ qe') s Sk �L , q� � �s�- Sr i� t qQ.5' y i ra�/i 5 ��-e,�-t��C� r1�1�R-S-F-�ln5 Zg� 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) �000 gal gal gal gal Effluent Filter Manufacturer: BeSt I Effi�e�t Fnte�Modei�� GF10-8 min.12" (typicaq SOIL COVER 12" min.trench depth criP��a�� '. �� TYPICAL TRENCH � � . - -� � �� '�:a� �-. CROSS SECTION VIEW 34" �' � (rypical) •',' ' • . �NO SCB�@� , a • : . • •° Provide minimum 3 ft System Elevation —97�00 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap ObservationPipe �yPICAL TRENCH (typical) (Show location of inlet/ outlet pipe connection on plan view.) (typical) Install per manufacturer's PLAN VIEW instructions. (No Scale) � - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - - -� n � - - - - - - - � � �A= 3.Oft �- - - - - - - - - - - - -�� /`- - - - - - - - - - � 1 �tYPical) � � B = 64 ft - � rn (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typical) � (mfd by InfiltratorSystems,Inc.) � Install pursuant to manufacture�'s instructions. 16 Quick4 Std-W @ 20 f� EISA/chamber= 320 ftz '� + � Pairs of end caps @ 6 ftz EISA/pair= 6 ftz = Proposed EISA per trench= 326 ft2 Required Infiltration Area= 643 ftz Distribution Method: x 2 trenches = Proposed Total EISA = 652 ftZ branched manifold � PAGE 4 OF 4 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= 450 gPd; BODS<_220 mgL"'; TSS 5 150 mgL-'; FOG<_30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nulsance 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 dishibution cell prior to dasing c dosing irregularities-if applicable(i.e.,pump re-cyding,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 ceRified 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 shali be cleaned when necessary to remove any accumulated solids according to manufacWrer'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: BUtt21"f12IC1, IIIC. Phone: 715-634-8�76 Local government unit: SBWyeI'COU11ty Z011lllg _Phone: 71 5-634-8288 �oca�government unit address: �0610 Mairl St. Suite 49, Hayward, WI ZiP 54843 Any defective part of thls sysiem shall be repalred,replaced,or removed pursuant to SPS 383.51 (1),Wisa Admin. Code.Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisa 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,Wisa 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. '°'�`''��"'��`� PRIVATE ONSITE WAS1'E TREATMENT county ��- ��. i� � �y� ��j� o`$P 1 SYSTEMS SaW er �'_�� S /~ ( POWTS) Y NU�-��',` i=s'-"�`'''� INSPECTION RI=PORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � � _ ' t� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. I 5.04(1)(m)] Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: � I-� Q� K�✓�� wAcT � Insp BM Elev: BM Description: Parcel Tax No: l.�,o �{-v 6� ��C. �� S� ��- oio-4��-�.� � �3�5_ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic W;�' (� Benchmark �pG,d' Dosing Aeration Bldg.Sewer 9$,,15-� Holding St/Ht Inlet q$a!/r TANK SETBACK INFORMATION St/Ht Outlet �t7,7s- � TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic •I�c` ,}�' �o` i-to� NA DtBottom Dosing NA Installation Contour Aeration NA Header/Man. q6 7� r Holtling Dist. Pipe PUMP/SIPHON INFORMATION Infiltrative Surface �:75� Manufacturer Demand Final Grade Model Number �P�� TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W 3 � � a. � #of Cells Type of System Distribuiion Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �.,��, INFORMATION P/L Bldg Well Waters °� G � Chamber o EZFIow Model Number: CELL TO � �2..s -�-�� ❑ Mound o Other � _ _ _--- � �-- _ _----- - -- -. ___--�---— DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold �Distribution Pipe(s) X Hole Size X Hole Observation PipE:� Length Dia Length Dia Spac Spacing 0 Yes ❑ No _ SOIL COVER Depth Over Depth Over �epth of Seeded!Sodded (� Mulched � Cell Center Cell Edges I Topsoil _ ❑Yes ❑ No � ❑Yes ❑ fJo COMMENTS: (Include code discrepancies, persons present,etc.) ��=�.��1� 3l�(�0�3 , - - __y Plan revision required?❑Yes ❑ No 'D'- O � � ��j � �(o � a � �� ----___ Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITIONAL COMMENTS ANO SKETCH SANITARY PEAMIT NUMBER: ��^ (1 � _ _ �L v � ; ___.._ :__ , _ ___ _.:_ _. ; ._.. _.: _ .:_ _ . . . . _-- _.__ �S � , , w'��- _.__ _ ' ��I��• !; p �3�� °`n'�� 3 ' �� fl, '� - - - - - ------ ��a �—� �/c. �� o � QY+� �3a`� � �\6 �n. �� -- � SCALE I"=