HomeMy WebLinkAbout014-842-16-2106-SAN-2022-117 �"r�`="''-"�i�, Industry�Services Division Counry �, '
'�� � 4822 Madison Yards Way S8wye1' �
� Madison,WI 5370� �
�' �. S p �'= Sanitar} Pcrmit Number(to be filled in by(
, �, a , P.o.so.�3oz �'i 1 1 �
��;�;,�;``,.:,-,; Madison,WI 53707 � � �
State Transaction Number �
Sanitary Permit Application _
ln accordance�vith SPS 383.21(2),Wis.Adm_Code,submission ofthis form to the appropriate govemmental unit �
is required prior to obtaining a sanitary pennit.Note: Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ac �
the Departmcnt of Safety and Professional Services.Pcrsonal information you provide may be used for secondary ���� �� � ���,t� �� J
purposes in accordance�cith the Privacy Law,s- 15.04(I)(m),Stats. p
I.Application Information-Plcase Print All Information
Property O�vncr's Namc Parccl#
SCOTT J & MELANIE A MERCIER 014-842-16-2106
Property Owner's Mailing Address Property Location
16008 COUNTY HWY D c��, Lo� Prt
City,State !_ip Code Phone Number
CORNELL, WI 54732 NE ,,,Nw ,, 5���;0„ 16
IL Type of Building(check all that appl��) ����t# T 42 N R 08 E o W
�1 or2 Pamily Dwclling-NumberofBedrooms 3 _ 6
Subdivision Name
I31ock#
�Public/Commercial-Describe Usc
�City of
�State O�«�ed-Describe Use CSM Number �Village of
26/126 #6879 ❑✓ �O"mO�' Lenroot
IIL Type of'POW"CS Pcrmit: (Check cither"New"or"ReplacemenY'and other applicable on line A. Check one box on line[3.Complete line C if
a licable.)
`�� �Nc���S�stcm �e lacemcnt S�stem �Other Modification to F.zistin S stem ex lam �Additional Pretrcatment Unit ex lam
✓ Y P" 5' g Y� � p" ) � P' )
B' �Holding Tank �In-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain)
(conventional)
C• Renewal L3efore �Revision �Change of Plumber �iransfer to Ne�v Owner
List Previous Permit Numbcr and Date Issued
Gxpiration
IV.Uispeisal/Treatment Area and'I'aok Information:
Desi�,n Flow(gpd) Design Soil npplication Rate(epd/s� Dispersal Arca Required(s� Dispersal Area Proposed(s� System Elcvation � �
450 0.7 643 652 92.50� �
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � �o � �
New Tanks Existing Tanks � o � ` Y � ro �
a U v: � v� u. U a.
sep���o�Hoia���rank 1000 1000 1 Wieser Concrete ✓ �
Dosin�;Chainbcr � � �
V.Responsibility Statement-1,the undcrsigned,assumc responsibility for installa6on of the POWTS shown on the attached plans.
Plumbcr's Name(Print) Plumber's ` aturc MP/�4PKS Nwnbcr 13usiness Phone Nwnber
Travis Butterfield 652879 715-634-8176
Plumber's nddress(Strcet City,State,7.ip Code)
14346W St. Rd. 77, Hay rd, WI 54843
F'I.Cuu t}�/Department Use Only
'7 Pennit Fee Date Issucd Issuing ngent Si�nature
�A �o� ❑ Disapproved -
� ' � , �r, � J
❑Owner Given Rcason for Denial $��� � �,�I�� �/����^`-`
Conditions of ApprovaUReasons for Disapproval
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IN CST � � _ o�� ►� � � - f��,
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J U N 1 6 2022 -�
sl�UVY�R C.��UiV�v
A[tach to complete plans for the system and submit to the County only�on paper not less than��[�1�1����'jTRAT�O(V
NO REFUNDS AFTER
sB�-��9s�R.ozizz� ISSUE OF PEAMIT
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version z�, 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
Mercier Home
Owner Name(s) : SCOTT J & MELANIE A MERCIER phone: - -
Owner Address: 16008 COUNTY HWY D, CORNELL, WI 54732 Zip: 54732
Project Address : 13711 W UP NORTH LN , HAYWARD , WI 54843
Govt. Lot: PRT NE � 1 /4 of NW � 1 /4, Section 16 , T42 N-R08 E ❑ or W ✓❑
Township: LENROOT County: SAWYER
Project Parcel ID #: 014-842- 16-2106
Designer Information
Designer Name: TRAVIS BUTTERFIELD Phone : 715 _ 634 _8176
Designer Address: 14346W ST. RD 77 , HAYWARD , WI Z�p; 54843
E-mail: OFFICE@BUTTERFIELDDRILLING . COM n },;� ,�,��z1 <�,�, �=�ar<�r- a��,� �,����.lst<�t,�U.
License Number: 652879
Remarks:
�
Signature : Date : � - �1 � ZZ
Origin ignature req on each mitted copy.
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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
�
Effiuent F�ite�Modei#: GF10-8
min.12"
SOIL COVER (typical)
'2„
min.trench
depth .
�riP��a�� •�. • � TYPICAL TRENCH
� • . -� �� �� '°��a��•. CROSS SECTION VIEW
� 34�� �` . .,. .. . � (No Scale)
RYP�cal) ;', , . .
. °• :
. • •' Provide minimum 3 ft
System Elevation —92.50 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap ObservationPipe NPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (typical)
Install per manufacturer's PLAN VI EW
instructions. �NO SCB�e�
� - - - - - - �� - - - - - - - ��- - - - - - - - - - — �
f - - - - � �A= 3.Oft
(rypical) �
L- - - - - - - - - - - �� - - - - - - - ��- - - - - - --� �
r- B = � �0�" ft —� �
m
(rypical) Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: (mfd by�n�i�trato�sy5tems.�nc.) �
Install pursuant to manufacturer's instructions.
16 Quick4 Std-W @ 20 fP EISA/chamber= 320 ftz �
+ � Pairs of end caps @ 6 ftz EISA/pair= 6 ftz
= Proposed EISA per trench = 326 ftZ Required Infiltration Area= 643 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 Operatiny Limits:
Design Flow= 450 gpd; BODS<_220 mgL-'; TSS<_150 mgL-'; FOG<_30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
c type of use
c age of system
c nuisance factors(i.e.odors,user complaints,etc.)
o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.)
o material fatlgue(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-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 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: BUtt2lflelCl, InC. Phone: ��5-634-8�7Fi
Local government unit: S2Wye1'COUllty Z011lllg Phone: 7�5-E34-H2HH
�oca�gover�ment unit address: 10610 Mairl St. Suite 49; Hayward, WI Z�p 54843
Any defective part of this system shall be repaired,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,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.
Continpencv 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 WASTE TREATMENT �ounty
�/�:o ���=r�
�,.�,
(>� � $P ��� SYSTEMS Sawyer
����j/ ( POWTS)
\`'''L'�s'—�="-' INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � � _ i `�
Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)] �
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
S�o-f}~ d-�'h�( �.,�'e. Me r���.r, ��- —
Insp BM Elev: BM Description: Parcel Tax No:
1
�d�-o Nq; � �Y"Y `�Y��" Ss:�^c. �- �� or _ �-- �L-� lo�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w�e � �p Benchmark (c�,o`
Dosing
Aeration Bidg. Sewer S g �
Holding St/Ht Inlet QS;pg'
TANK SETBACK INFORMATION St I Ht Outlet ��(, $� �
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic t�,S� k��` ` r NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man. Y 3 �"�
Holding Dist.Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
�
Surface �-Z.�
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist,To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS �N 3 � L y` #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ��
INFORMATION P I L Bidg Well Waters °� G � Chamber Model Number: 1
❑ EZFIow
CELL TO +','kj' } b� �►-?S� N o Mou nd o Other (�f fi
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 Seeded/Sodded Mulched
Cell Center l Cell Edges Topsoii _ �—❑Yes ❑ No 1 ❑Yes ❑ N�
COMMENTS: (Include code tliscrepancies, persons present,etc.)
� -�S�a�(.� 7��-7��.�
Plan revision required?❑ Yes❑ No �� �,� � � � � �c��'�
-��� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIONAL COMMENTS AN� SKETCH
SANITAAY PEAMIT NIJMBEA: �� � I �7
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