HomeMy WebLinkAbout014-268-00-3300-SAN-2022-126 .�
Indusriy Services Division County D>
4822 Madison Yards Way Sawyer `
-�� � Madison,WI 53705
�� = Sanitary Permit Number(to be filled in by Co.)
s P.O.Box 7302 �
Madison,WI 53707 L7��jnj � � S �
�
Sanitary Permit Application State Transaction Number �
Ui accordance with SPS 383.21(Z),Wis.Adm.Codc,submission of this fomi to thc appropriatc govcmmcntal unit 7�
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing addr� �
the Department of SaYety and Professional Services.Personal information you provide may be used for secondary Fat Tire Lane ^t�_
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. �I I
I.Application Information—Please Print All Information
Property Ouners Name Parcel t� �����, —pp— Q�
Christina Fanola 570142420802515268003300
Property Owner's Mailing Address Property Location
2831 Kenwood Isle Dr ��.
Ciry,State Zip Code Phone Number
Minneapolis /i/�,v ,����l0 3 _--��—c��s°�t�°°
�2
II.Type of Building(check all that apply) Lot tt T42 N R 08 E o
�l or 2 Family Dwelling—Vumber o£Bedrooms 2 33 Subdivision Name
s�o�ka N�c'�i c 'Q�� Q, �la��
�'ublic/Commercial—Describe Use --
❑City of
❑State Owned—Describe Use CSM Number illagc of
� �Town of L@flfOOt
II1.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 licable.)
A ❑✓ New S stem �e lacement S stem ther Modification to Existin�S stem ex lain) ❑Additional Pretreahnent Unit ex laui)
Y� P Y� b Y� ( P ( P
B' ❑liolding Tank �In-Ground �4t-Grade �Mound lndividual Site Design Other Type(explain)
(conventional)
C. �Renewal Before �Revision hange of Plumber �ransfer to New Owner List Previous Permit Number and Date Issued
Expiration
IV.DispersaUTreatment Area and Tank Information:
Design F1ow(�pd) Uesign Soil Application R�te(gpd/s� llispersal Area Required(s� Dispersal Area Proposed(sfl System Elevation
300 .7 429 �y� - q 3-�tS.�-�
Capacity in Ibtal #of Manufacturer
Tank Information Gallons Gallons Units � U V v �
New Tanks Exisring Tanks F o � � � � ro ti
a U v� y in r.i. C7 F.
Scptic or Nolding Tank 750 ]rj0 1 Wieser �
Dosin,Chamber � �
V.Responsibility Statement- I,the undersigned,assume respo 'bilit for installation of the POWTS shown on the attached plans.
Plumber'S Name(Prin[) Plumber's Sibma r MP/MPRS Number Business Phone Number
Dan Burch 253808 715.416.1642
Plumber's Address(Street,City,State,Zip Code)
N5921 County Hwy K Spooner WI 54801
VI.Coun �/Department Use Only
� r �d ❑Disapproved $emiit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial
Y��,QO -�? �:3`'� I�.�i �� rS.J--
Conditions of Approval/Reasons for Disapproval D � ��r2��
L�
��� �N� �s� �a - o����) JUN 2 1 2022 �
� ( _r-�
SAWYER COI�'�i!`��
ZONING ADMINISYRHT��i�'�
Attach tn complete plans for the system and submit to the County nnly on paper not less than 8 I'�x 11 inches in size
NO REFUNDS AFTER
SBD-639A(R.02/22) �c.,.SUE OF PERMIT
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version�Q,SBD-10705-P(N.01/01,R.10112),,,
�,,
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 A plication for Review
Soil Evaluation Report&Site Map
Project Name/Description
Owner Name(s): � r ' ✓.� 1��+''��`" Phone• -
1/ I j-y� �
i /v1 ,a����.,s N�.nl Zip: ,f'
OwnerAddcess: �`33� ����✓� �� �s<Evi ti �a' —
Project Address: Af ��'� L�
�evt_t6r q.fq-of �Section �� ,T�_N-R�E�or W�
Township: ��'�a�r
County: Stl"'l!y�'�
Project Parcel ID#: o�`� � �`�� �
Lo�33 N�f��4 5 ,e� N���
Designer Information
Dan Burch Phone: 715 _416 _1642
Designer Name: 54$01
Designer Address: N5921 Cty Hwy K Spooner WI Zip:
E-maif: Burchpiumbinginc@gmail.com
This space reserrzd for npproval stamp.
License Numbe�: 253808
Remarks:
� Date: 6� �7 `'�`�
Signature•
Origine� ignature fequired on eadi submltted copy.
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
Q✓ SOIL EVALUATION o Scale: 13o 30 as 60 ❑✓ SYSTEM PAGE 2 OF �I
SITE MAP PLOT PLAN
PROJECT NAME: �5, oesicN F�ow�. 300 GPD
F3110�2 . Attach design flow calculations for wmmercial plans.
PROJECT ADDRESS: F8t TIf@ LBf12 Pipe Material/ASTM S[andarcl(Tables 384.303&384.30.5)
N SanitarySewec `SCh 4� PVC /
BM Symbol: � BM Elevation: ��� FT Force Main: /
BM�s��P,;o�: nail in12"oak '
�ndicate rronh by I MPORTANT:
Slope Gradierd(%) Well Symbol(if applicahle)'. 0 drawine an arrav Show ground elevafion contours a[suifable intervals.
of T¢slBdlvea'. - on Ihe approPrite lirie.
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Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA � ��esz �-
Uniform Elevation Trenches with Quick4 Standard-W Chambers 7 �� SepticTank(s) Volume(s):
3-ft Trench (down-sizing credit) gal 9a� 9a� gal
�� �� IJ� Effluent Filter Manufacturer:
/
I �� �
Effluent Filter Model #:
min. 12"
SOIL COVER «P��'�
12..
min. trench
depth •
c�vP��ao � • � TYPICAL TRENCH
• . -� �� � �'.a � •. CROSS SECTION VIEW
F` avP��ao �:;� �• �' � � . . (No Scale)
� . • .. . �.
. . ' ,i Provide minimum 3 ft
System Elevation — �� ft separation between trenches.
(typical)
Quick4 Standard-W
w/ End Cap Observatan Pipe TYPICAL TRENCH
t ical (Show location of inlet / outlet pipe connection on plan view.) (typical)
� yp � Install per manufacturers PLAN VIEW
instr
�n°ns. (No Scale)
� �q�re�ear— — — ��.�_— — — — — — — — — — — — — — — — — —
�tlM YYY'��'1f��!tr �� yyoty � ''� �� �; w �I�F�N!l�t�
I �; �I A = 3.Oft
0
i � (typical) �
�r rrY�I1�r1� i�rr�rilYiYUYt� Ari �rirrw.. rr� tarrra�r '
- - - - - - - - - - - �� - - - - - - - ��- - - - - - - - - - -� G�
B = � ,t ----I m
(typical} Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: �rntd by ��fl�tratorsystems, �nc.) �
c�,/ Install pursuant to manufacturer s instructions.
� Quick4 Std-W @ 20 f� EISA/chamber = / � � ft2 �
+ � Pairs of end caps @ 6 ft` EISA/pair = L� ftz
= Proposed EISA per trench = � ftZ Required Infiltration Area = �� � ft� Distribution Method:
x ( trenches = Proposed Total EISA = / `� b ft2 /7 e��
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 Oqeretinq Limits:
Design Flow= 3 J O 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 adivities,efc.)
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(sl 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(113)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: D811 BUI'Cfl Phone: �15.416.1642
Local government unit: SBWyef COUllty ZOillllg Phone: 715.634.8288
Local government unit address: 1061 O M8i11 St. #49 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,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 county
;,�: ,.
�=j� � ` ��
jx � o `�j SYSTEMS SaWyer
`���� p$ ( POWTS)
\ -�W
°`Ess'—��'"= INSPECTION REPORT sanitary Permit tvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� r- ���
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#:
�f� '�k �ha� ,nn,b `—
Insp BM Elev: BM Description: Parcei Tax No:
loo.� ` �4�l ��, 2" I� o� — �6�—on -33�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
eptic �, ;
—�S-o Benchmark �p�.p'
Dosing
Aeration Bldg. Sewer �$,� `
Holding St/Ht Inlet q7,$�
TANK SETBACK INFORMATION St I Ht Outlet q7,6�
TANK TO PIL WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic .��,5 N ,i-3-S� fia5` NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �](�,,�
Holding Dist.Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface �f S 1
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 W �1� L #of Cells � Type of System Distribution Media Manufacturer:
Conv ❑ A re ate `�
�
SETBACK OHWM of Nav � gg 9 '
INFORMATION P I L Bltlg Well Waters � GP � Chamber
❑ EZFIow Model Number:
CELL TO .}-� ` -�-� N �/ o Mound o Other ��
DISTRIBUTION SYSTEM � x Pressure Systems Only
- -
Header I Manifold l 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 Cell Edges Topsoil � ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code tliscrepancies, persons present,etc.)
���i l� 7 ��� l a�
Plan revision required?0 Yes ❑ No �� �� �3 I , 6���� �
� —
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL C�MMENTS AND SKETCH
SANITAAY PEAMIT NUMBEA: �'o� `Io��
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