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HomeMy WebLinkAbout026-938-08-6002-SAN-2022-144 � '`'"'��� [ndusCry Services Division County �.� , _ 4822 Madison Yards Way `z ; _.. s p = Madison,WI 53705 Sanitary Pertnit Number(to be filled in by Co.) = P.O.Box 7302 Madison,WI 5302 � ��� �y � � Y� Sanitary Permit Application State Transaction Number � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to[he appropriate govemmental unit �� "� 7^�1 -f �- C-- � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS aze submitted to Project Address(if diffcrcnt than mailing addres = the Department of Safery 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. 1621 1 W Conners Ln I.Application Information-Please Print All Information Property Owner's Name Pazcel# GBS Group LLC Q26938086002 Property Owner's Mailing Address Property Location ��c�t' bI7 Trunberry CT Govt.Lot 10 Ciry,State Zip Code Phone Number Northfield MN 55057 507-649-1903 �—� Section 8 II.Type of Building(check all that apply) Lot# T 38 N R 9 E o �or 2 Family Dwelling-Number ofBedrooms 3 �„ Subdivision Name _ Block# ❑Public/Commercial-Describe Use �� ❑City of ❑State Owned-Describe Use CSM Number ❑Village of r� f,�Town of Sand Lake IIL Type of POWTS Permit:(Check either"New"or`Beplacement"and other applicable on line A. Check one box on line B.Complete line C i a licable.) `� ❑ New S stem �te lacement S stem y p y ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain) B' ❑ Holdin Tank ❑ In-Ground ❑ At-Grade �Mound ❑ Individ�al Site Desi g gn ❑ Other Type(explain) (conventional) � C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner _ist Previous Permit Number and Date Issued Expiration �y-3�� � /p IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 450 � I � 450 450 104.9 Capacity in i'otal #of Manufacturer Tank Information Gallons Gallons Units � � o � � New Tanks Existing Tanks � o � � Y p � � a U v� y v� i.i C; 0.. Septic or Holding Tank 3000 3750 2 Weiser x Dosing Charnber 750 V.Responsibility Statement- I,the undersigned,assume responsibility for installadon of the POWTS showo on the attached plans. Plumber's Name(Print) Plumber's Signa[ure MP/MPRS Number Business Phone Number Kelly Ferguson 224069 715-416-4597 Plumber's Address(Street,City,State,Zip Code) W9502 Dock Lake Road Spooner WI 54801 Vl.C unty/Department Use Only �A �b e ❑Disapproved Permit Fee Date Issued Issuing Agent Signature ❑Owner Given Reason for Denial $ l ��•� �1/ �� 'r��- ."l�t^�^�`""!'�^"'"'�'�' Conditions of Approval/Reasons for Disapproval ,�� , � • _ ' 'j;v''�''i'.��.,� � `�ri i —�� � r�J� � r !:� �,I i_. ; i _� -- l._ c_ � � S� �a- — C��o ��'' J U L 1 1 2�Z2 --��� � �� �'� � � �-----------�: ����;��'Y�'ra C�:::�'fv;Y Attach to complete plans for the system and submit to the County only on paper not less than 8 U2 x 11 inches in size • SBD-6398(R.02/22) NO REFLINDS AFTER 19SUE OF PEAMIT \,rr'+t=rva�r [)IVISiON OF INDU3TRY SERNICEB `i 10541 N RANCH RD � WAYWARD WI 54843-8462 (sr r ��+ - Contect Through Re�ay ti. . P S http:Ndspa.wi.gov/programs/indusUy-senncee ��r,, _ www wiscOnlm gov ,� '• _ ,Y;. '��.i�,..� Tony Bvm-C;ovornor Dawn C�im-8�entary July5, 2022 _ :,��or�;�_,,, APPROVED � � ,,.. . . � .�.zAL CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES:2024-7-5 ����� Plan Review: PWTS-072201422-C Kelly Ferguson W9502 Dock Lake Rd Spooner,WI SITE: GBS Group LLC 16211W Conners Ln Sand Lake Township Sawyer County S8 T38N R9W FOR: Description: 3 bedroom-450 GPD—24"to Mound Component Manual—Ver. 2.1 (May limiting factor-Effluent Filter- Maintenance 2�22_2�� required. Pressure Distribution Component Manual—Ver. 2.1(May 2022-27) -- ----- — - -- - - **New� �n� � � ��o into�ffect 7/1/2022 and submittals ,_� � . � � The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes.The submittal has been CONDITIONALLY APPROVED.This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The owner, as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • The site shall be properly prepared prior to plowing.Any grasses longer than 6"shall be cut short and removed.To avoid matting,any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps.Avoid operating equipment on the Mound site. If necessary,use only tracked equipment,during dry conditions,with minimal passes, to avoid compaction. • Components and soil remaved from an existing drein field shall be properly disposed of so that there is no risk to public or environmentai health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec.145.19,Wis.Stats. • Inspection of the private sewage system instailation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec.145.20�2)(d),Wis. Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copv of the approved plans,specifications and this letter shall be on-site durin¢construction and open to insoection bv authorized representatives of the Deqartment,which mav include local inspectors. Owner Responsibilities • The current owner,and each subsequent owner,shall receive a copy of this letter.Owners shall also receive a copy of the appropriate operation and maintenance manual(s)and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes.Reports shall be submitted at intervals appropriate for the component�s)utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2j,nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, �jo��wu��2o�ul�y Joshua Rowley POWTS Plan Reviewer,Division of Industry Services 715-634-5124 �==' "`� ---- _ � ' MQI�ND AND PR�SSURE �ISTi#I��l�IQN �OII�PiO►t�E�iT �E�IGIMi � _,._ �;:1:3i r.r�F. ' -:(;;'•'i iranEx k�a �-rnE �a�� Prc�ject ��m�� ��S Gror�p LL� G]wners Irl�rr�:. G�3S Group L?C ' - ._._.. .A...._. .. n�r�r �r �w�cTv nu1Z � '-_'_�.'�"_"...,�,,.._ ��R��r�. �. . �O�rr�ers �.cidr�st 617 Tun��r{Y �,� ;�3�v�sioN ; ;, - A1£�rt�1�iE(d_MN 550�� _ . �.��ri /�.,�er/v . .� v -�- �t7 r-4'iA*�'--T 9�'1:� L�:gal De�ri�,ti�r=: C`x�v�t. Lot 1Q � $ ; �3 f� 9 L`�' T�7��;st�i�. S3r�+� L�ki; 'ft��.�Cy. S�WY�r S:�t�a�ri�a� Nar'�c: Lr�[ Nurr;b{:r: 1 p .. _. 3it�s:�t Nt�m.ber. flarr�i I :7. h��t11�7+t;r: 2t�3�3Q�f'a[}C�2 �t,�r Tra�;a�c�►s�r� Ma.: �'ag�e ` Inr�ex a�� t�tle �'� � D�ta �n.tr,r �a�e 3 �lou��i ctr�unngs ��£ 4 L�t�:'�i a�d ��a�� �nk R�le 5 �yr�ar_•m m�i�t[�nance s�ifir�tie,r,c P��' � h��rf�c�emt�€it ��G �Gnt�tl�cf?Gy ��ct ��� 7 P;�r!'?p Cu;v� ar�+� sp�c;ifiG�'ic�n5 Cies�ar�Pr i�eiiY_���svra LsCenS� �lu�tlbCr. 224^u�i9 U�C�; 4��;u2;~�� F'•10rt� NU�iI�?e�: �7y�i�-4��37 SignahJtE?' �..� `� �' � ^,-„� hR.--{►� t� ,y-st 1' 1 Desigr� F'ur�.u�r�1 t� !hr, ��touc'od C:t�as�hyn�snt M�nUaI `�f f'C}`�'V'r; 1Ie*�:�c�r1 �.�9 �(}-'.'�6G�':-f' thl. 4?1�01, 12. '=��12;i ::nd b[sfh SS'JtIM�' P�licatu�n 9 £� pi�;�rt nf Pre�sure Dist��uti�n t�a�t+•�s i� ST-a,�',,S f�J1tF311 an� Fr��sure D�is'�ibut�an C:am�n�€;1 h4�ariu� tifer. 2_0 SB�J-10i�-Y iN OtIK}'+. R. 1G�1Z} '��rsion 7.0 (R. �'f11�'} Pa�� ` c�f 7 i I�llvund and Pressure Di�tributi�t� Compvnent I}esign "_.. a','�-.;:._�._- Sibe Inf�mation �:i� ;:���::;:� R �t�tctc��ial or C�mrs7er�a�:� Desigr• �tc,tr e��ru;,���.a���s ass�e a ; _-30�_�00 �ss►�„atfd Uda�tewacer F"�v,v r9�d� T:�t�ir 3&3-04-3 in sit��sail tm_at�nr�t it�' f _ _�._..__. f�xr:al��,�Idnm^;��F �j ttir_#ww. 1.5U �'E�klr�y F�r:lcz� (�.t� 3 5= 151��`aJ __._..__ �.._.___�� �45�_G�� �+ysi�n�=F�►v (gp�j 3_4D S�te�IoF� f°+�I ��3.9Q ;:�Can�D�r Lir��C��rat�t�n (fta �4.U0 Gep�h t��i�'►iU�'t� Fac�or t�n; �___,__.0.6Q In-sit� �:A�tplic�'ir�n R;�t�{gC,�d�C`� � . Distribe�#ion C�ell frrfor�7�lfion �.________ _ __.SD,U� d!sper�C�II �,.�ne�th A��C�Rt4Ur�ft) = 9.Qi3 (:�II lNsd#fi (ftj � ._.__ 4 Oa f�E��€:rs�: Celf E}e�ign ��di*�� F��te{t�*��`R't ;_ �Ji In�uer�t�+'Va�tew�a�er t3i�aliiy(1 �r 2) hrie ft7e lat�i;�ls tt�e�i�h�st poi�rt ir,the�:sscrbutia� Y i PceSsur�e 1)isributi�'t Iltf�fmati�� n�'.vrork'% -. :�-'r �,r'U ;t:: ��,; ;�. ; C; Cert�'e�End Ma�i�ald �.��J L2ter�i ipar�r� #ftl ff N at�,re �n�r�h��.'v�tlon;ft) �5'; Nc�mF�r�f i_�t�r3�5 ut t'i�hic,'��3t ps�arrt ^ ' i 0."t$$; C?r�fiu:C�.a�mct+:z i;sn; _ ._ _ __ __ , ; 2.i)d! _��:}��t.�Or�fiCe ��c�nq (ftr= - ��� `t�,;^:���e n �.QQ F OfC�i"fl2tcl L?€t]€nP_t�r f;r1i 70.Ql�` ��t�em�i� Leltgth #f�) Uoes[t�� `orc�rnain d��in i�;,k'� Y 9�,40^. Rum� Tank�I����tit�ti (ftj c-r,*r.r�':^..,.'tr! i.?5 S�stem H�d i;ft;x 1 3 , 1?.�� �arce•ma�n�ra�r�rxacc�; (g�l) � ,3' i.��rtic��l.ift(ft� � n"_f� r�i 5x Vu►�V41ume{.[,��'1 :3_i�� �riGt�n �.�5�,:!�� 78.'�1 �.�inim�m �c�'.e�'�.d�tur�;p�l;i 0.� tr-[in��t��r I +..;�.;(�;1 ��.1�} System t�eman� (9�m� 1� ??� Tt�`'�I t3y�arrsir. H���;�! ' Later�l�'��amQt�r�eEectian ; M�Rif�c#t�iameter S�l�c�tion ;n r�i� � ,r�;ivr.s _ choice n cia. ; cp�i�r,s �tr.e�,��e� � ?� �y �µ 1..�� � ____. 1.�� i x 1 �,�� ; 1.2� x ; � [ll;� x x 4 1.SC� . x x � 3.OG __._.__.... 7 ;lp x � s__.__ ��.�34 x �afbar�stinch Calcuiatar .�_�r�` �^s:�� Tr�.�tm�r�t Tank 9�amFatk�n ;S�G.t�U; Total T�r�;k Cap�c�tq{�alj �4D�.�0 ��tie�:"�s,k�ap�t�ty,.�a�� ` �1� �JO; Tokal YVor�cirrg�iq�it� pe�t� jin; v'J����.____ ._. 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'"F,.?{1� w ��L/`ti �t: t�►w�`��C_,G�'r��� t � � � - � L . •.( sl �asn. 1'-aJ' •� +i� f.:. �,'� ''+x) . { ' a � ( �,���,;�����— . ��, } � *i��}r r.����s�,st�:n�,�t•cil�r_zebt i�.:—�J�IrYt ,� ��'�j�nm c3hsn:-�ti:;n.�.�: ��n F J�1 :� r � �f�a' � f� �� ��� ,r }�.�t�',('� !� .1 �f � l� ��, � 1�I l� ��ri` t� �-�.�.., __—�----- `�-, � _ ,� ���-�� '� _— __ _ �l — y i � �f �� .�_ , , � �,� �� , � �.�����,�:��`�,�t ►�- � � � ��a I � � � � t I i i� � ..Ar _, t+ V . � �.�ti, � '�Z� :ti � � 1 � �� ,:����`�j .k .,{J.� i ty `�i. , � f. 1 ,��f—' ( f" �� f ��'=�t��� ��l � � � -, '^�-- � � �� ,{'��� 'S/'j � ��1�:.` k� %�,`�j��, �j ;�' � i � ��� 1 r�r.�n.�� � �b �-` �� r ` a��� ,r ` ,� ` ` r+l � F �_ ' i i;r� �+ {r � \ ', � 1c�-�� � (4.4.k ��l�y.G I!`�/'•' ,.` �.�s��-��`t'`�```:� ��',�, r� �' :- � � �. � C ti pr,. • t { ' �, / i �I - � ,� �,i ' ' , � ; � � � f f - rr' /`' � f -�i �— �,,�'t r'F � r t ± ,.� �, �� c �.-� �, ;{ �` -- r t� �o,,►� . �. �� �`j r {�,: �� -" ;�,��f� \.� �� � �'' �, �'� �� ���� i �, � � \� 4 � '� � � �� � �� '' � ._,,, �� `�!- - ---- � � , . --__ � %"'�T'"��`�;� PRIVATE ONSITE WASTE TREATMENT county ;y=- . ,%� � r�"� o$ -, SYSTEMS Sawyer ,� p �"� _ s ( POWTS) `�\�F`_`�;, �""�'�=^'' INSPECTION REPORT Sanitary Permit No: Safety and Buiidings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� _ ��( � Personal infonnation you provide may be used for seco�dary purposes(Privacy Law,s.15.04(1)(m)] Permit Hoider's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: Cri QS G��� C. C L �� La� �3 --o��2o j k1�- � Insp BM Elev: BM Description: Parcel Tax No: �O�.p� a .7: h..a� 1�. 2 t�S�� li D2b—`�31�`d�� �oa TANK INFO MATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �&�� �p-o� Benchmark OO.o` Dosing e,,, � Q � Aeration Bidg. Sewer - Holding St/Ht Inlet - TANK SETBACK INFORMATION St/Ht Outlet �'�Y6' TANKTO P/L WELL BLDG AiRiNT°KE ROAD Dtlnlet qy,Q6' Septic NA Dt Bottom q j,r(, ' Dosing .;-�� {-�,5� i ` NA Installation fi�-S �'�S Contour Aeration NA Header/Man. Holding Dist. Pipe IoS:4� PUMP 1 SIPHON INFORMATION Infiltrative , Surface oS,� Manufacturer �- Demand Final Grade Model Number � � GPM TDH (� Lift Friction Loss Sys Head TDH Ft Forcemain L (�o' Dia �� Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W �j� � $Zj ' #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° COnv � Aggregate INFORMATION P I L Bldg Well Waters °� G ❑ Chamber Model Number: ❑ EZFIow CELL TO -I-S -r� � fi�� �_ _Mound_ � Other --_—_------- -- DISTRIBUTION SYSTEM X Pressure Systems Only Header 1 Manifold � Distribution Pipe s)i �� � X Hole Size X Hole � Observation Pipes� Length � Dia_,Z�ength�.2� Dia �'� Spac 3�a � O,($g � 5pacing�•�� Yes ❑ No _� SOIL COVER � _ __ -- - — -- - Depth Over ,� Depth Over �1„ i Depth of a Seeded/Sodded Mulched Cell Center �- � Cell Edges �y Topsoii � _ �Yes ❑ No �Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) �.�,�11,� �I�-Y l '�� � �.T � �,���a Plan revision required?❑ Yes❑ No � �� ��� ^ � � � �� � �I��.�3� �--_-�� �ti��i� � � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01} ADOITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NIJMBEA: a,�-L��_ � �„�.(I�� �. ���� ��,�� 'Q�� M.� � p �� � � ., . , � w� � �1�h�� � « �., �q� � ����r, ? � � �o����y„� � � �` ��. . �. bD � � \ � / Q �� / , . �� , , ,� ��� �� . �� _� �,c �,a'�' �� � �,o b � n� 1"=