Loading...
HomeMy WebLinkAbout028-742-31-3210-SAN-2022-125 � � �" Industry Services Division County � 4822 Madison Yards Waq Sawyer - � Madison,WI 53705 s P = Sanitary Pennit Number(to be filled in by Co.) � S P.O.Box 7302 ���O � � Madison.WI 53707 � Sanitary Permit Application State Transaction Number —� In accordance�vith SPS 38321(2),Wis Adm.Code.submission ofthis fomi to the appropriate govemmental unit '— � is required prior to obtainine a sanitary permit.Note Applicahon forms for state-o�vned POWTS are submitted to Project Address(if different than mailing addres �� � the Department of Safery and Professional Services.Personal information you provide may be used for secondary ����� ��/��f ��. �a�/ard W� purposes in accordance with the Privacy Law,s- 15 04(I)(m),Stats. V V � I.Appiication Information-Please Print All Information Property O�aner's Name Parcel# Joshua & Melissa Kellner 028742313210 Property O�i�ner�s Mailing Address Propert� Location 33822 County Rd 72 c��t l��t City,State 7_ip Code Phone Number Zumbro, MN 55991 507-923-6847 "W ��,S'" '/<, Section 31 IL Type of Building(check all that appl��) Lot# T 42 N R 09 E or �l or2 Famil�D��-elline-NumberofBedrooms 2 �3 SubdivisionName Block# ❑Public/Commercial-Describe Use �Cit��of ❑State O��ied-Describe Use CSM Nwnber Village of 25/295 #6789 0✓ To"�,of Spider Lake Ill.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 licabie.) ��� �lew Sy�stem �eplacement S��stem �ther Modification to Existing S��stem(explain) �Additional Pretreatment Unit(explain) B' �Holding Tank �In-Ground �At-Grade �Mound Individual Site Design Other Type(esplain) (comentional) r• ❑Renewal Before � I.ist Previous Permit Number and Date Issued ✓ Revision ❑Chanee of Plumber �ransfer to Ne�+O���ner F=,P��at+�� 22-027 (Revision from HT) 1V.Dispersal/Treatment Area and Tank Information: —.2 —� Design Flow(epd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(st� S��stem Elevation 300 0.7 429 452 95.04 Capacity in Total !!of Manufacturer Tank Infonnation Gallons Gallons Units L ` o 'o _ New Tanl:s E�isting Tanl:s '` _ � ` � p � � 0 c. U �n v, cn v. V a. Septic or Holdine Tank 75� 750 1 Wieser � Dosing Chamber � � � V.Responsibilit)'Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signat MP/MPRS Number Business Phone Number Jason Kuettel 675751 715-798-3355 Plumber's Address(SVeet,City,State_Zip Code) PO Box 66 Cable, WI 54821 VI.C untv/Department Lise Only � .t Pennit Fee Date Issued Iss�ing Aeent Sienature pro e ❑Disapproved . f},,✓ $ �O � C��� >�y:� -�"v)�1.�..�.k� " ��-� � ❑Otiner Given Reason for Denial � �� � %�t r� Conditions�f Appro;al/Reasons for Disapproval D ����� � t , �^ �� f`'b GS� �� — V' 1 ll' �—��i � ��, � �I I ,-� JUN 2 2 2Q22 � . � -� �-� 5 A 1V .,'�t.,�- C� ��1 _— K2.��c�� T� . .SA1�'VYER i C�t.lti�..,.� � S `' � Q +'� � � �{7V� -f ,��ll�,lj;r�l;7�f{{�e{��� Attach ro complete plans for the scstem and submit ro the Coun[�•only on paper not less than 8 1,2 x 11 inches in size saD-639g�x.o2i22� NO R�FUNDS AFTER ISSUE OF PEAMIT PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version �Q, SBD-10705-P (N.01/01 , R. 10/12), , , a�i 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 Keliner - 2 Bedroom Septic Owner Name(s): Joshua & Melissa Kellner Phone: 507 _923 _ 6847 Owner Address: 33822 County Rd. 72 Zumbro, MN ZiP: 55991 Project Address: 12059 Wolf Ln. Hayward, WI Govt. Lot: NW 1/4 of SW_ 1/4, Section 31 , T42 N-R09 E ❑ or W ❑✓ Township: Spider Lake County: Sawyer Project Parcel ID #: 028742313210 Designer Information DesignerName: Jason Kuettel Phone: �15 _ 798 _3355 Designer Address: PO Box 66. Cable, WI ZiP: 54821 E-mail: tim@andryras.com License Number: 675751 Remarks: g Date: � z i z�`'` Si nature: ,� s� Original sig required on each submitted copy. nu�r��� �nv �^ �on� irno� - �. .�.�.. .�..,. ,..., r,� . ._i......��. ❑ SOIL EVALUATION o Scale: 4'�= 40' 60 8Q a SYSTEM PAGE 2 OF SITE MAP PLOT PLAN PROJECT NAME: cPp (10ftgrid) ��'- DESIGNFLOW �G�' Kt��f'�2 �����r-'� -;�`3�'�� Attachdesignflowcalculationsforcommercialplans. PROJECTADDRESS �O,S `t �,.lv`� C�+ . j�f�-Yl�/•4i-� Pipe Material / ASTM Standard (Tables 384.30-3 8 384.30-5) NSanitary Sewec `� ��Sut `i� / BM S/mbol -$r BM E!evation ����� FT — ,r�� Force Main: -- / BM Descnption: _� G� �'�"Q-'{-G_ S1�4-i3 S�ope Gradient(%) � , ind�ca�e �onn by INiPORTANT: �/ell Symbol (if apolicab!e)�. � drasvin an arra,v of Tested Area: � o� cne apProprrte rr,e. Show ground elevation contours at suitable intervals. �O�i u�'LS-=----;7TGS}�v�'T �'--� M L'U SS� J�-� �� N C��- � : � � �� � �. . , . , . . .-'- -- . . : . ' ._ _ - _ . :4�'�z�s5 : 3 3'�zz �`�-�-��r i� � 7 z ; Z,,M�r�� .,,.�.i ' ,- - - - --- , ---;- - —i � � ; - -- - - -�- � ----- ; , , , I ; _. 3 �^ Z S �fi 67 - -- -- =— ' ! � �- �-- --- — --- • - - ---- — --- , _ _ . �C(��t-- N 1--� f t,., L�T � c_.,S� � ' ' � . — - -- - -- ' _--�Z� � . � � � � i � � I - -- ; , ---- - - -- - � ! - _— S 3 i i y ZN" f-z�� � � � � , o � � I --.----- � ----- - -;- -- `_ r—`_ - , - -- -�h� 1 _ � i v, , � ; i � — - - ' ----�- -- =---{— ---�-- -�-<N ��?� ►'� ', 6 Z�7 �z 3 13 z.) � � � -� - -- I- --- — - ---_ -_ . ---- - -- ----;-- ----�--; --- - ---- - - - ----� — `l� n� � ( ---_c 17 L2' � -` ��L- , ' 1 l-� C S. ; i --- --_ ___ �_ __... _ _ _..___ _ - — __ �_ __ __._ - -- - ____ _ -- - --- --- _..__ _: � `j L ft_ � ' ; j � � � U I _ _ � _.—_�� _-S,'�-U- --- - ----" �----r- � � - - --- - ------��;__ � , � - - ,- _- �_ I ; ; , , � i � i ; � , , I ---:_ �.. -- ; ' ' ; . - - � -- --- F ' - — — �.— '� � � � � � i i � , ; _ _ - ; i i , i i � i I I ..__.— _t—___,._.—r.--i-s—.r—+-- � , ... __-_. -' . -` ...�.' ��, I ' I � ' � I : � � I � 1 I -- � __ ; � � i + ; _ �—. _ .. -. _ __ � _ �__ __. --""---[.;t . .-- _ ' P , i i ; ; ; 1,:G5�' , � . I i ! I � � i - --- -"�---� ' ! : I. _ . -.__ ._ __.__,_�_ - - • . : , -._._... _ .._. �-- - - - - - � — - � . ._...-- —� � p . -,-_-�. —i. 1 � � � J � -- , � /C._ � � i 1 �: � _ v . i �i i i ( i � � I � _'__.- - ___ .__.. _ _ . . ._. . . -'_ , t : __..' ' ___ ._' —'_ _ _ _ � _ . _.'__ .__'_ _' ��:-_ � � � i j j i j —r _ . . _. _ _ ". ..��^�._�� _U. � � I — ., — ' ' - _ '._ __ _ - _ __._ _.—_ . _' _ '— -' _ _ -T_ i � ' � � — 7'7.�4 , : � - �,��;� � _ - --- r-- --; _ ____ 1 ' _. , _ - • ' �- I _ _. 4'� �-� - - - �� , — - - ----- ; �� - , , �i .�{(� � ' �i�- � Z _:. , - , --� : __ �--__ �Z _ � _ -- . _. _—'�-_____ � �1JL , _____ � c+�s i �/� � c� - - - - -- -- I_ ' r _ / 7. ��� ' ' � ` ; - -:-- - ,,- --- _ -- _ l�3 - _ __ : _ _ - - . {�.. _ �ro,� i=����, �,� cv Cs�c,�--� I _ _ - -- - -- - -- S`15;�n..-�� - `�S�o`'� �� � d _ _ _ _. . _ - ._ __ _ _ _ __ _ ._ _ � . �� ; __ • - ----- � __ - � - - � --- ; — r- —'- --' ,.-- r.i�� i3, , \ ' ; � � � �� ' � ' � >5'0 �r+� - — -- ___ I , , , � ' , ; i Gfz.. � ' ' , --p�c�+� ,<f�..1�:_ _ - fT_ i _ --- _� _ __ _ _- _ , � I � - - _ -- --- r -- , , . � � � : , � _. _ _ �--_�__ �_ ._�__.�__ _ ' �- � , , � , . ; _ _ _ - - - - - - - , ; , � , � , � , � ; i � , � ; ; � � ' —� _ , , : , ; -_ , � i --- -- --- � - �� ; - , . -r-- -?---,`-- — �-_ .__. . __ ,/ . ___._ i i_ , , . � ; i ' -- -- � ; �z�e , ° __' � � � �� � , , , ; ; , , . , 4� I _ _ _ _� - ---- - - ,- ____ q _ - -- iS3 � ` � ' ; , -- ���u��t _ � � , , , � _ _ G�s�r.5 � , ' : . . . . _ 1 .. __ ___... . _ __ . . ..._ . . . _ . _. I . ...__ .. -. ... . . , . . . _ , . .. _._i __'_I .� __ ._..___ ��- .'__'__ �._. . .� � � I� �' � . . .__. . . . .._ . _ . _. ... ._ _ _ ' ' . . ' .'. a. . _.._ . �___ ' __' _ i ,L� ��-� . . ._-_ _ � , I e , , / I . �. . .L.___" . ___'__,-a-._._'�— «__ '__.. . . _ 'I �L_ . , . ... _ __. � - -. . _ _ ,' _. __� _'__ ' _ . _." _ � , � � . . ..—_1_ ^ I � I I i _. _:. .. _. .__ _ __. . . . __ : , . _._ ' . i.__ � .1 _. �. _ � ... : . I j � � , ; I _ - _ _ `- -- - '- _ :- --- ' I _�` , ' ---- � . : / __ . . -- -_ . � � : � _ I ... . 1 ` , 1 I i � �� V`� .. I _ . . . _ __. _ — ' __ _ ' � , y ' __ " . . . . . ._ __ . . . � I � � ` : 6�5�-�� 1 , ' ! ! � I � 11,.P �� ; -- , . __ ___ _ � � ' LurP1Ll-j-lyou.� e6 lzr � P r� I co I Septic Tank(s)Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA wieser Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s): 3-ft Trench (down-sizing credit) 750 gal gal gal gal Effluent Filter Manufacturer: Orenco � Effl�e�c F�icer nnodei�: FT-0822 min.12" SOIL COVER (typlcal) 12" min.trench depth «P��a�� � • TYPICAL TRENCH - �- - � °.a �<. CROSS SECTION VIEW r 34 .', (typical) •,-', ` (NO SCaIe) w � a . • ° Provide minimum 3 ft System Elevation — 95.04 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap (Show location of inlet/outlet pipe connection on plan view.) Obse;�pi ai�ipe nPICAL TRENCH (typical) Install per manufacturers PLAN VIEW Instructions. �NO SCB�@� �mRaww�wl�sww�se7[1RIv11lw'— — — — �� — — — — — — — �� — — — —w!#lfA�slRtfw •�11�l�wf� IWaar��farrrr��ar�irrr iYii���lYiiYrl+�r�rrrr�^II �A= 3.0 ft � - - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - � cryP���> D ;-- B = 46 fc --I m (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typica�) Q (mfd by Infiltrator Systems,Inc.) � Install pursuant to manufacturers instructions. 11 Quick4 Std-W @ 20 f� EISA/chamber= 220 ftZ � + � Pairs of end caps @ 6 ft�EISA/pair= 6 ftZ = Proposed EISA per trench= 226 ft� Required Infiltration Area= 429 ftZ Distribution Method: x 2 trenches = Proposed Total EISA= 452 ftz branched manifold RESET 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 5 220 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 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: AIICII')/R2SI'TlUSS21l 8c SOIIS, InC phone: 715-798-3355 �ocal government unit: SBwyer COUtlty ZOi1111g Phone: 715-634-8288 �oca�9overnment 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. 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. �/t�i�-�' E` � PRIVATE ONSITE WASTE TREATMENT county f���\ i��r o$p ;�i SYSTEMS SaW er �«�s j ( POWTS) Y ��is—'"��`' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION ���.��s' Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04{1)(m)] Permit Holder's Name: ❑City ❑ Village �,Town of: State Plan Transaction ID#: T� .�� �-��,s 1c�-I 5 � lA�� '_ Insp BM Elev: BM Description: Parcel Tax No: ��.0' b� y.,.ol e co.� . o�-$-� 7�t�_ ) -321 D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �..�es�i,f- '7$a Benchmark �pp,p� Dosing Aeration Bldg. Sewer �;3 ' Holding St I Ht Inlet �}7, � � TANK SETBACK INFORMATION St I Ht Outlet qb.$S' TANK TO PIL WELL BLDG vENr ro ROAD Dt Inlet AIR INTAKE Septic }o N $y fi ' NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. `j(,,oY' Holding Dist.Pipe PUMP/51PHON INFORMATION Infiltrative Surface �'�OY Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist. To Well DISPERSAL CELL INFORMATION DIMENSIONS �N 3 L y y #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv o Aggregate ��� � INFORMATION P�L Bidg Well Waters � GP p� Chamber Motlel Number: ❑ EZFIow CELL TO }-�c7t (� �/ � _o Mound o Other - Q,f,� 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 1 Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Inclutle code discrepancies, persons present,etc.) � ��1�l �l�gl�.z Plan revision required?❑Yes❑ No p� �� �.� - ����� � --- —__. Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITI�NAL COMMENTS ANO SKETCH SANITARY PEAMIT Nl1M8EA: �2_ (�-� o-- __!� T�, �..�1��dl : _, . C�� , , . , ; . , . . _ . . , ��l ' _ - _, __�_ �.� . . . - �_ --- --_ — - - --_ _. �_ . __ _.. ._ , I _ , , , , 'Q (� fi�o i Q . . :_ _ . . .__ : YX � : . . , �� � . _ . ` � _. . .__ . _.__ � a _ ;.. . _ '^ �� �� ; _- -�— � --- - — _ � + ' ; ; � �i° ' � . _._ . , _. ;._. A o.. _ . ._ � ��� . ;. ._. __ _;.. ,_..., , � ,- _t , ' � � � � _. � . .. ._ ; : _ _ : b, ��p . _. . __ _ _ .; . � a � � � � T ._ _ . . $, _ ; __ . _ . � ._ _ .___ . Gp ;... i ��� . �g� � n` ��� 'V� � � — — � � � � �•�1. g��¢ J l- _ _ � �� � � ����w �-- � �.o"`¢' s��E€ �°- r�--o "�°`� � �