HomeMy WebLinkAbout024-741-30-5416-SAN-2022-120 �
` ` Industry Services Division County �
4822 Madison Yards Way SeV�/ef �
- �S' - Madison,WI 53705 Sanitary Permit Number(to be tilled in by Cc �
t P.O.Box 7302 �
Madison,WI 53707 � j�� � � �-� t
Sanitary Permit Applieation State Transaction Number c, \
X-�
In accordance with SPS 38321(2�,Wis.Adm.Code,submission of this form to the appropriate governmental unit �- G
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing addri
the Department of Safety and Professional Services.Personal information you provide may be used for secondary �O�O�N FIIt@r Ba Rd. Ha ard WI
purposes in accordance with the Privacy Law,s- I�.04(I)(m),Stats. y � ,
I.Application Information-Please Print All Information
Property Owner�s Name Parcel#
Eric & Beverly Knoernschild 024741305417 & 024741305416
Property Owner's Mailing Address Property Location
2220 Oak Valley Dr Uovt.Lot 4
City,State Z,ip Code Phone Number
Muscatine, IA 52761 715-462-4063 '�, '%, se�t+o� 30
II.Type of Building(check all that apply) Lot# T 41 N R �� E or W
�/ I or 2 Family Dwelling-Number ofBedrooms 2 �
Subdivision Name
Block#
❑Public/Commeroial-Describe Use
�City of
❑State Owned-Describe Use CSM Number Village of
33/26 Q✓ Tow„or Round Lake
III.Type of POWTS Permit: (Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i
a licable.)
�� �New S stem Re lacement S stem Other ModiYication to Existin S stem ex lain Additional Pretreatment Unit ex lain
Y � p Y ❑✓ g Y ( P ) ❑ ( p )
Add Pump Tank&drainfeld to Existing Holding Tank
B' �Holding Tank �ln-Ground �At-Grade �Mound Individual Site Design Other Type(explain)
(conventional)
C• ❑Rene���al Before �Revision Change of Plumbcr �I'ransfer to Ne���O���ner Li;t Previous Permit Number and Date Issued
Expiration �7-3�$ (0 �Q �
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Desien Soil Application Rate(gpd/s� Dispersal Arca Required(st) Dispersal Area Proposed(s� System Elevation
300 0.6 500 500 100.66
Capacity in Total #of Manufacturer
Tank[nformation Gallons Gallons Units � � o 'g �
Vew Tanks Existin�Tanks ,.'�- " U �' '�
u
�' ` 0 � � y � cG @
n. U rn � v� i,. U a
sePdc o�Hoid���Tank 3000 2000 1 Rasmussen ✓
Dosing Chamber 500/800 1300 1 Wieser � Q �
✓
V.Responsibility Statement- 1,the undersigned,assume responsibil'ty for installation of the PON'TS shown on the attached plans.
Plumber's Name(Print) Plumber's Signat MP/MPRS Number f3usiness Phone Number
Jason Kuettel 675751 715-798-3355
Plumber's Address(Street,City,State,Zip Code)
PO Box 66 Cable, WI 54821
Vl.Coun �/Department Use Only
� Ap ro�e ❑ Disapproved Permit Fee Date[ssued Issuins Agent Sianature
� � � �� � �
��� ❑Owner Given Reason for Denial ���• ���� (�� ���r 1 V f�_,(,�y'f;�,-�' ��=�
Conditions of Approval/Reasons for Disapprova( r � t-�.�`-�'� ! ��.-��� - -�
` �! � `� ��1`��� :� I`
t.�• �U c��l--.�: �l 1
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��l��Soc 7l� a�,-2-��-T� C� �- SAWYER GO ,,-.
� ZONWG ADidtiPdlS"��i:1��Ti�;.
Attach ro complete plans for the system and submit to the County only on paper not less than S Irz x 11 inches in size
sB�-639a�R.ozizz� NO REFUNDS AF'TER
iSSUE OF PE.�tMIT
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version �, SBD-10705-P (N.01/01, R. 10/12) . , .
4,l
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Knoerschild - 2 Bed Lift
Owner Name(s): Eric & Beverly Knoerschild Phone: 715 _462 _4063
Owner Address: 2220 Oak Valley Dr. Muscatine IA ZiP: 52761
Project Address: 10101 N Filter Bay Rd. Hayward, WI
Govt. Lot: 4 1/4 of_ _ 1/4, Section 30 T 41 N_R�� E ❑or W❑✓
Township: Round Lake County: Sawyer
Project Parcel ID #: 024741 30 541 7
Designer Information
Designer Name: �ason Kuettel Phone: �15 _798 _3355
Designer Address: PO Box 66 Cable, WI Zip; 54821
E-mail: Jeff@andryras.com
License Number: 675751
Remarks:
Signature: Date: f��/L`2z
Origi s' nature required on each submitled copy.
CHECK BOX AS APPLICABLE. C!^ECK BOX AS APPLICABLE.
❑ SOIL EVALUATION o s`�1e: ao 40 so 80 � SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: ��o ft gnd) ��z DES�GN FLOW: 3�C GPD
KNOL�,k.4-��L� Z �t� Attach design flow calculations for commercial plans.
PRO,lEC7 ADDRESs Pipe Materiai / ASTM Standard (Tables 384.30-3 8 384.30-5)
/eo �, ' `� Sanitary Sewer: y �J�G� �-fU /
BM Symbol: � BM Elevalion: FT
Force Main: Z SG°t'`'� � /
BM Description: l�t' cC-f.=�-"��-�— �L �
SlopeGradient (%) r Indicatenorthby IMPORTANT:
a ld Well Symbol (if applicable): � drawing an arrow Show ground elevation contours at suitabie intervals.
of TeSt2d ,4rea: on the approprite line.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
� m��. ,z•
Geo�eztile I I cnP��o TYPICAL TRENCH
Cover
SOILCOVER CROSS SECTION VIEW
12• (No Scale) OBSERVATION PIPE DETAIL
min. trench
depth (No Srale)
(�ypical) L — r — — � ,', Screw-Type or
SIiD Cap(loose) ,� �"':.r'� Finis�etl Grdde
(mulchetl 8 seedetl)
SystemElevation/100.66g • • •. �� 4"OPVCPipe `'.� ToP�aco�a�
(typical) � � Pfovideminlmum3ft Topolpipeto�emiinate (mi�. irooq
at or above finisM1etl g2de
separation between trenches.
(4)V4•'-1/2••X 6"Sbis
@9b apa�
TYPICAL TRENCH (Show loca[ion of inlet/ outlet pipe connection on plan view.) qnclionnq �eviw i�rua�b�
PLAN VIEW - S��a�
(No Sca le) 4u � Observalion pipe shall�e installetl
aljunciion betweentwo units. "�Q
Perforated Lateral Ohservation Pipe ft
(typical) (rypicaq OyP�cap
- - - �f - - - - - - - - - - - - - - - �—�
� - - - - - �
� "____' ______° '--" _'_ '_'____ � A — 3.0 ft D
-- ------
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- �� - - - - - - - - - - - - - �
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(typical) W
INSTALL PER TRENCH: EZ1203H Bundle 0
(typical) �
5 10-ft bundles @ 50 fl' EISA/unit = 25� ft' (mfd by Infiltralor Systems, Inc.) �
Install pursuant to manufactureYs instructions.
+ 5-ft bundles @ 25 ft� EISA/unit = ft'
= Proposed EISA per trench = 250 R' Required Infiltration Area = 500 {�' Distribution Method:
x 2 trenches = Proposed Total EISA = 500 ft� branched manifold
RESET
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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 panding in distributian 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(sl 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. RepoR any component failure or malfunction to:
Name of individual or company: Alldf�/ R8Sf71USS@Il 8c SOI1S, IIIC Phone: 715-798-3355
Local government unit: SaWyel" CoUllty Z011lllg Phone: �15-634-8288
�oca� govemment unit address: 10610 Main St. #49 HayWard, WI 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.
Continqencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, i� 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.
PAGE50F6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vent Pipe
>ronr�m
Building Eleclncal musl comply wilh
1Y'Min.or2.Oflabove SP5316andNEC300
Es�ablished Flood Elevation Wealherpmof Exlend manhole nser as necessary. -
(typical) Jurction Box
Approved qpproved Locking Manhole
IMPORTANT: Ventiap wilh Wam(gPLa;elAttached
t i�l
Anchor tank(s)as necessary
pursuant to SPS 383.43(8)(g) ---cona�a a^Min.or z.o n anove
Es�ablished FIooC Bevalion
(typical)
�Airtigh�Seal
Finishetl Grade �
Quick Discoanect
18"Min.
CAPACITIES @ 11.82 gal/in . � _. avv��o
Depth (in) Volume (gal) • d �
A 23.3 275 'r �
Wel p ��Appmved Joinls wi�h
B 2.� 23.64 A i Hale "PP'sotlaPc�o�a°n��
� (typicap
[C] 5.7 67.71 I
_Alarm
D 12 141.84 B 8_0�
I [c] PUMP-0FF
* 43 � P°mP �—off ELEVATION = $9 � ft
Pump Tank Liquid Level = in �
° INSIDE BOTTOM
Force Main Diameter = Z in c°"Ce`a
ai°°k ELEVATION = $$�� ft
Force Main Length = ��� ft 3'^PP�o°e�aeaa��9 nnaie�ai ae�eam ra�k
Vertical Head = 11.66 n
Force Main Void Volume = 2�•�� gal
+ Min. Supply Head = NA ft
[C] Total Dose Volume TDV = 67.71 gal/dose
+ FM Friction Loss = 5.61 ft
(5X total la[eral void volume <TDV<0.2X tlesign flow)
+(force main drainback volume) + Fitting LOSS"' = NA ft
"(min.supply heatl x 0.3)
MIN. PUMP DISCHARGE RATE = 4� gpm = TOTAL DYNAMIC HEAD = �7•2� ft
PUMP TANK: SEPTIC TANK(S):
Volume = 500 gal Total Volume = 3000 gal
Manufacturer: Wieser Manufacturer(s): Rasmussen (Existing)
Pump Manufacturer: Champion
Install approved effluent filter at the seotic tank outlet
Pump Model: CPES3 immediatel u stream of the um tank inlet
(See a�tached pump curve.) Y P P P
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Orenco
Controls/Alarm Model: HW 101
Filter Model: FT-0822
Float switches containina mercury are prohibited.
hd111 1011 �� 1/3-1/2 H P
p - � EFFLUENT/SUMP �
�. _o: �� ..,�_ � .: .,�-__...'.' �,_
pEvery pump tesied in water to ensure pump
1 meets peformance curve.
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U 'J U U L U 'J
Tx:4038825
A�39787
RESTRICTIVE COVENANTS pAULA CHISSER
IN RE: �EGI�TER dF DEEDS
�AWYER �C3UMTY, W�
��I20/2022 02:57 PM
RE�ORC�ING FEE 3�.fl0
PAGES: 2
�S�eQ a-�+�� �99�d�.s�s,`�'���.
Retum to:
Sawyer County Zoning Dept.
10610 Main Street, Suite #49
Hayward, WI 54853
STATE OF WISCONSIN )
) §
COUNTY OF SAWYER ) a�y��y�_30-Syl7
Parcel NoS.
o1y-�YI- 30- SY/b
��2.t c A'1. LC/VB G 6L'NSC E4<<--�� , being first duly sworn on oath depose and state that
they are the owners of the property described hereinabove, and fiuther state that the following restrictive
covenants shall run with said property described herein:
1. The above described parcels may not be sold separately without permission from the Sawyer County
Zonir�Officc.��,5�;�sys�eqsew�e�'�""
�
Dated this�d day of 5�-� , 2p Z Z
� ��� .
Owner Owner
ACKNOWLEGEMENT
STATE OF WISCONSIN )
) §
SAWYER COUN1'Y ) �
Personaily came before me this, �,'O day of� ,20��the above namod individuals,
�.�i Ce �� 1`�'1�>� ✓ r' �jC.. � � ����_;���q�e lrnown to be the persons who executed the
foregoing instnunerrt and acl+nowledg�d the same. ��e`N'�Y C����s,,>,
� ��o� ••i�,�4 •";r,�:,n.
� , j� •
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(Print Notary Name) �� .�;�i����° .`s n
Notary Public,State of Wisconsin / ;��j� ���7"�����5�,�,>�-� This document drafted by:
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Parcel#1- Part Gov't lot 4,Lot 1,CSM 33/26#7946 poc a�3���3
Sec.30,T41N,R07W
Sawyer County
024-741-30-5417
Parcel#2- Part Gov't lot 4,Parcel A,CSM 1/291#214 poc��3769�
Sec.30,T41N,R07W
Sawyer County
024-741-30-5416