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Home My WebLink About010-133-00-1600-SAN-2022-136 ' Industry Services Division County vn 4822 Madison Yards Way Sqw e�- � ; �_ -, Madison,WI 53705 Sanitary Permit Number(to be filled in by Co ps P.O. Box 7162 � Madison,W(53707-7162 �,,� ��j� 3 y � Sanitary Permit Application State Transaction Number � � 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 fortns for state-owned POWTS are submitted to Project Address(if different than mailing addi � the Deparlment of Safety and Professional Services.Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. �(�� 01 N ��' � � � L Application Information-Please Print All Information Property Owner's Name Parcel# �c�m O 1 O - 1 3 3 -U� 1 (o C�(7 Property Owner's Mailing Address Property Location �� a �� Govt.Lot City,State Zip Code Phone Number }�� N,�p,t'�� VJ Z ,Sy a y3 '/<, '/e, Section 3�2 II.Type of Building(check all that apply) Lot# T y/ N R�_F;-or �l or 2 Family Dwelling-Number ofBedrooms � � � Subdivision Name Block� ��c�1g.�Wqpd S o� (-�a �d S�.bd. ❑Public/Commercial-Describe Use �City of ❑State Owned-Describe Use - CSM Number ❑Village of 12�Town of W QY W 0.r d _ [Il.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. A� �New System p y g y ( p ) ( p ) � Re lacement S stem Other Modification to Existin S stem ex lain Additional Pretreatment Unit ex lain B' � Holding Tank �In-Ground � At-Grade gn yp ( p ) � Mound � Individual Site Desi Other T e ex lain (conventional) C• � Renewal Before Revision � Change of Plumber � Transfer to New Owner �st Previous Permit Number and Date Issued Expiration IV.Dispersal/Treatment Area and Tank Information: p (��:e�t 'i P vs �0.n.fx�t w/ 07 Se i S aF t n� Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 3vo � � s �� o �, � a � q�.so , 93. as Capacity in Total #of Manufacturer � Gallons Gallons Units a, o '� � Tank Information � v � y U y � New Tanks Existing Tanks � c a� L « � �y � 0 o. U v� �, r� i.�.. C7 ri Septic or Holding Tank � r,J-� --� 7 S� � �/J�C S<<' C.OY�C K'�C- X Dosing Chamber V.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumbers Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number }Z�.a�d A S rec1�►STr �/� a.a �Co�bB 7i5-S5"8-Co`-1'`I'� Plumber's Address(Street, ity,State,Zip Code) Sa�sN sr 2a �7 l-IaYward� w� s�vati 3 VI.Coun /Department Use Only �App o d ❑Disapproved f ermit Fee Date Issued Issuing Agent Signature 9 ❑Owner Given Reason for Denial $ ��'� � ��I�� ',I'r^�`^�-rN '""" " '" Conditions of Approval/Reasons for Disapproval , t ,a�; , � �� .:�y�.-, ^��i' �'` :�r � �EJ � �� IN� �-�- � - � �-� 0 � J U I� 0 7 2022 SAWYER Cb�.�`�iTY Attach to complete plans for the system and submit to the County only on paper not less than 8]n z 11 inches n s�ze NO REFJNDS AFTER SBD-6398(R.03/21) ISSUE OF PERMIT PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: �fefs+ea-2-9,SBD-10705-P(N.01/01,R. 10/12) v��s;�,. a.� h�7 aoaa 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 Pfan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report&Site Map Project Name/Description Sake-County Highway'E'- Lot 16- Hidden Woods Owner Name(s): �ames Sake Phone: - - OwnerAddress: PO Box 1212 ; Hayward,WI Z�p; 54843 Project Address: 10012N County Hwy E Govt.Lot: 1/4 of 1/4,Section 36 T 41 N-R 09 E❑or W ✓� Township: Hayward County: Sawyer Project Parcel ID#: 010-133-00 1600 Designer Information Designer Name: Ronald A Spreckels Jr Phone: �15 _558 _6472 Designer Address: 9205N State Road 27; Hayward,WI Zip: 54843 E-mail: ronspreckels@yahoo.com License Number: 226688 Remarks: Signature: //l��.�� Date: 6�/o4Ja2 Original signature qui d on each submitted wpy. . �„� • o ' � , 3 i hl 17 I m \ � � � W a c� D w y o e g 9 � � � �� M � 3 � p 6 �, v p► ` , r i o -v � n`� -an /��11 6 =o i � y 4�p Y n. T s � yw oq *k �o . �Y � . r 0 � �� 9 � � G1 �l G� w u + -1 In r � U, v — � n 3 "e s � c � o R s � +- o (/� . 1� � � Y n .°� �- x � ! � � � ' ("7 l� .1+ ,� (T� S � � �y �' P (3 n �, � � v � 1� a _ -L � � .D C C r� E '�e ; � Ti C, � .' . ry Z � O � I ( i I � I 0 I C I � I � � '� � a � � ° � � i � � v , p e w n .' & � W � '< z O � I I r QJ W O � � '� � - 4'' I I "„ I `+' I ''` I � I Z I L �v � -"• ; 3 0� o. o � � `, v ,. � � � I Z . � � _ .� I 1-� � � � �' F''" � a-£ c � -� '� O - 2 11 '� z � O A n� \ IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manufacturer Wieser Concrete Inc; Ste��ped Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) SepticTank(s)Volume(s): 750 gal gal gal gal � _�,_ I � Effluent Filfer Manufacturec SGIL COVER Lifetime Filter LLC mi�.ir �ryui`'��) EHluent Filter Model#: LT-�IH 12. min.Vench TYPICAL TRENCH aeaN CRt�SS SECTION VIEW �ryP1Oaq • (NO SCeI@l ' " �'". ' Provide minimum 3 ft � � 34" " ,—=i . separation between trenches. (bPlcap , , . Highest Trench Lowest Trench (as applicable) System Elevations== 94.50 ft; 93.25 ft; ft; ft; _ ft Quick4 Standard-W w/End Cap Observatbn Pipe TYPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) Ryai�9 Instellpermanufacmrets pLAN VIEW Instmcnons. �rfO .SC2�2� � - - - -- - - - - �f- - - - - - - - y'� - - - -yeb�.►nrr:e s�t — � - L —��- -- - - � - - - - -��- - - - - - - - �� - - -'`i►rt�arr�o��Yi�� [A= 3.Oft � J (bvica�) '� � - D I-� B = 63 n -� —�I m (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (ryP��) � _ (mfd by Inflltrator Systems,Inc.j T Inslaq pursuan,to manufacturers insimctions. 15 Quick4 Std-W (c� 20 ft� EISA/chamber= 300 ft� � + � Pairs of end caps @ 6 ft'EISA/pair= 6 ft' = Proposed EISA per trench= 306 ft� Required Infiltration Area= 600_ ft� Distribution IVlethod: x 2 trenches = Proposed Total EISA = 612_ n� 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 yPd; 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, efc.) 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 distai 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 Seatic 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 (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 wili 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: ROtl81d A SpfeCk@IS Jf Phone: 715-558-6472 �o�ai 9o�e��me�t„�;t: Sawyer County Zoning & Conservation Pno�e: 715-634-8288 Local government unit address: 1061 O M81f1 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),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 approvai. 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"`; PRIVATE ONSITE WASTE TREATMENT �ounty ��oSP� '`�`"� SYSTEMS Sa,W er �� POWTS) Y ��"`�/ INSPECTION REPORT Sanitary Permit No: �x,s��>.,.�i Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� r 131 Personaf infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] b Permit Holder's Name: ❑City ❑ Village [�.Town of: State Plan Transaction ID#: ��+►M2.5 ��+K�— q wa� '_ Insp BM Elev: BM Description: Parcel Tax No: t �oo_v Np,� t- 'c�'�o�w►.� �-- a-6'` w�;,�-��-- o lo-�33_p d -I�6 o a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS NI FS ELEV Septic �,,;Q,�- 7S'� Benchmark �po ,o� Dosing Aeration Bldg. Sewer - Holding St/Ht Inlet Q��` TANK SETBACK INFORMATION St/Ht Outlet 4�F,�3` TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIR INTAKE Septic �3� N �fo� .y., a� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. q��S� Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative q�S,, Surface 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 W 3 � L �p ga #of Cells Type of System Distribution Media Manufacturer: Conv o Aggregate T � SETBACK P I L Bldg Well OHWM of Nav � �GP � Chamber `� I ' INFORMATION Waters � AG a EZFIow Model Number; CELL TO � e` � ` o Mound � Other QY.� -- _ -- - -- -_ __- 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 i Depth of Seeded/Sodded Mulched Cell Center � Cell Edges I_Topsoil � ❑Yes ❑ No � ❑Yes ❑ N� COMMENTS: (Include code discrepancies, persons present,etc.) ��.��,� ��:�f�.� Plan revision required?�Yes❑ No p3 � � a3 �� j�j�b ��O � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) ADDITIONAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA: o�-�--13�0 . : . : . : . . . . 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