HomeMy WebLinkAbout024-741-06-3108-SAN-2022-121 " '� Industry Services Division County �
_ ,� 4822 Madison Yards Way S0.w er �
_ \ �_ -- Madison,WI 53705 Sanitary Permit Number(to be filled in by Co �
P= ' P.O.Box 7162 3
Madison,WI 53707-7162 �`��'1 � � � �
State Transaction Number �
Sanitary Permit Application � i
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if diffcrent than mailing add
the Department of Safety and Professional Services.Personal information you provide may be used for secondary �
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � a U�y w N� ��re.�� Rd
I.Application Information-Please Print All Information
Property Owner's Name Pazcel#
An � ,� �- a�;�kn� G�0.11 Oa�-1-7�-I1- GC.-3103
Property Owner's Mailing Address Property Location
I 07 1n : n H�ll Dr Govt.Lot
City,State Zip Code Phone Number
E�/�IG, SW '/<, Section �!o
G����,�, w= s3oay
II.Type of Building(check all that appiy) Lot# T �� N R 0"7 -L}o
�l or 2 Family Dwelling-Number ofBedrooms (s ��l t a� 01 Subdivision Name
Block#
❑Public/Commercial-DescribeUse �
❑City of
❑State Owned-Describe Use _ __ — CSM Number ❑Village of
Csh � J438 �'ownof 1�oun� LaKc
vo�, t1 p . ��3
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 if
a licable.)
`� � New Sys[em .p� p y S Y � P )
,o�Re lacement S stem Other Modification to Existin S stem ex lain Additional Pretreatment Unit(explain)
B' � Holding Tank �In-Ground � At-Grade g YP ( P )
0 Mound � Individual Site Desi n Other T e ex lain
(conventional)
C• � Renewal Before Revision � Change of Plumber � Transfer to New Owner ist Previous Permit Number and Date Issued
Expiration �3 -�q a �(�-p/cl 3
IV.Dispersal/Treatment Area and Tank Information: QO (�u1GK SI P lvb Cl�+o..mbu� w/ St af en�
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
9OC� O•S I $00 � 8 � 8 � $9.50
Capacity in Total #of Manufacturer
Tank Information Gallons Galtons Units � � o � �
New Tanks Existing Tanks � c a� ` � y c`� �
ci U V� v, +/� t�. C7 G.
Septic or Holding Tank „�r•O * �� �� a0 a i CSQ� C� / � x
TL
Dosing Chamber
V.Responsibility Statement- 1,the undersigned,assume responsibility for ins Ilation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plum .'ignatu MP/MPRS Number Business Phone Number
a ;so�K � a3oa3Co ��s- ti�� ��9
Plumber s Address(Street,City,State,Zip Code)
l(o ��� S 1-�wy �3 H�y war d � w z' .5 y 8 y 3
VI.C un /Department Use Only
� Ap rov ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�L�/ ❑Owner Given Reason for Denial $ `Ov`� � I�� I`�`r ��l'""1 �""""�3--
Conditions of Approval/Reasons for Disapproval D � 5��r,-�� �� �`
,�. ��� L%
��
�� � �A � JUN 2 0 2022
CST �� �� U
SAWYER COUNTY
ZONiNG ADMINISTRATIOI�
Attach to complete plans for the system and submit to the County only on paper not less than 8 tn x 11 inches in size
NO REFUNDS AFTER
ssn-639s�R.o3izi> ISSUE QF PEAMIT
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.�
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
Gradall - Hildreth Rd
Owner Name(s): Andrew & Brittney Gradall Phone: - -
Owner Address: 1607 Indian Hill Dr ; Grafton, WI Z�P; 53024
Project Address: 12064W Hildreth Rd
Govt. Lot: 1/4 of SW 1/4, Section 06 T 41 N-R �� E � or W Q✓
Township: Round Lake County: Sawyer
Project Parcel ID #: 024-741-06 3103
Designer Information
Designer Name: Ray Visocky Phone: �15 _634 _ 1679
Designer Address: 16222 S Hwy 63 ; Hayward, WI Z�P; 54843
E-mail: visockyph@gmail.com , . .,, ,� �� .� ,�;;�_,,�„ :
License Number: 230236
Remarks:
Signature: � "�" 1 Date: � �7 �`�
Origin signature requir on each submitted copy.
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Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete �nc
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) 1250 9a, �5o gal gal gal
Effluent Filter ManufacNrer:
Lifetime Filter LLC
i
errwe�c F�ne�rnoaei n: LT-1/8
min.12"
Mp�ca�)
SOIL COVER
12"
min.trench
aepth
cHo��n • TYPICAL TRENCH
< CROSS SECTION VIEW
�— 34�� No Scale
(bPlcal�,.�' . . � �
� ' Provide minimum 3 ft
System Elevation = 89•50 � separation belween trenches.
(typical)
Quick4 Standard-W
w/endCap ObservatbnPlpe TYPICALTRENCH
(typical) (Show location of inlet/ outlet pipe connection on plan view.) ��stall perYmanNacNreYs
PLAN VIEW
�°s`�°"�°°s (No Scale)
r— - --- - - - �f— - - - - - - - �� - - - — � T
I , , � '3, _ ' �� �. � I 1A= 3.Oft
� — - - - - - - - �� - - - - - - - �� - - - - - - — � chP��o D
� B _ i2s ft _ � -I m
(ryplcal) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: ��Yp��l� O
(mfd by Infiltretor Systems.Inc.) �
Install pursuant to manutacNrers instructions. �
30 Quick4 Std-W @ 20 fl� EISAlchamber= 600 ft�
+ � Pairs of end caps @ 6 ft EISA/pair= 6 ft�
= Proposed EISA per trench = 606 {�� Required Infiltration Area= 1800 ry= Distribution Method:
x 3 trenches = Proposed Total EISA = 18�$ ft� branched manifold
PAGE40F4
In-ground Gravity Management Pian
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 heatth hazard if not maintained in accordance with this approved management plan.
Furthermore, ail 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 = 900 gpd; BODS <_ 220 mgL"'; TSS <_ 150 mgL-'; FOG 5 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 distributio� 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 Iaterai 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 W is.
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 filterlsl 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: R8y VISOCKy Phone: 715-634-1679
�o�i 9o�e��me�c ���t: Sawyer County Zoning & Conservation Pno�e: 715-634-8288
Local government unit address: �OF)"I O M81f1 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.
Continaencv 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.