HomeMy WebLinkAbout010-941-20-3205-SAN-2022-147 ` Industry Services Division County �?
4822 Madison Yards Way S Gw e� �
- �s P : Madison,WI 53705 Sanitary Permit Number(to be fillcd in by C �
= P.O. Box 7162
Madison,WI 53707-7162 (,�3� � y y �
Sanitary Permit Application State Transaction Number �
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit —�
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a _[
the Department of Safety and 1'rofessional Services.Personal information you provide may be used for secondary �
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. �q�...��
[.Application Information-Please Print All Information
Proper[y Owner's Name Pazcel#
�"�a�k�n�e.�v .� r•,��.���� M�K0. v , o -5� � - a� 3a�S
Property Owner's Mailing Address Property Location
I O'7 S$ N M1vh�re� �1'.\ co�c.Loc
City,State Zip Code Phone Number
��0.�v�ACC�. � W Z s"�-�I a y 3 �W '/<, �+J '/a, Section e�O
II.Type of Building(check all that apply) Lot# T y� N R �'9 �E-vr
'�'1 or 2 Family Dwelling-Number ofBedrooms � _ � Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑Ciry of
❑State Owned-Describe Use CSM Number ❑Village of
CS M #�1 GS G 9 [�rown of ya�w o.rc�
vol. . lo`i
Ill.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 �[lviceplacement System Other ModiYication to Existing System(explain)
Additional Pretreatment Unit(explain)
B' � Holding Tank � In-Ground � At-Grade � Mound � Individual Site Design Other Type(explain)
(conventional) �a
C• � Renewal Before Revision � Change of Ptumber � Transfer to New Owner List Previous Permit Number and Date Issued
Expiration j���O�� 31 /� 2�',
IV.DispersaUTreatment Area and Tank Information: � p F� terwa.� ac.a �d � � ��••o So' ce»S 4.5 r S�
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
ySU ►. L Cbaso.�� a a�.a s (►�as�� ;� 4 tis Cb4s.�) S B . 8 3 � �-
Capacity in Total #of Manufacturer
::
Tank lnformation Gallons Gallons Units � U v v �
New Tanks Existing Tanks ` o y � Y � � �
n. U v� H v� w CJ Li.
Septic or Holding Tank �_ O� 1 OQ� � ��Q���e�� �
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for instAllallon of the POWTS shown on the attached plans.
��� Plumber's Name(Print) Plumber's e MP/MPRS Number Business Phone Number
�
Gz.-�.�a �'�-.��� G� qso � i � ��5-S s s- i� 3 g
Ylumber's Address(Street,City,State,7_ip Code)
i 3 sdaw F��.,�.� R� }-�b..y�o��, w r SLIs y3
VI.County/Department Use Only
�Ap�i c56 � ❑Disapproved Permit Fee Date[ssued Issuing Agent Signa[ure
❑Owner Given Reason for Denial $ `���� � I�3 f �P ���^"^�'���"
Conditions of Approval/Reasons for Disapproval �, -- � - �-�r
C) �,�+ r � ,
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�l cST �� — � ��J J U L 13 ?022 �--
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SAWY�l� Ct7L,!�!i Y
��:+iViNG AD1�;��srH,ar��a
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398(R.03/21) NO REFJNDS AFTER
13SUE OF PERMIT
PAGE 1 OF 4
In-Ground Gravity Pian
Index & Cover Sheet /`
Component Manual Design References: `�e����
Version 28,SBD-10705-P(N.01/01,R.10/12) �yM(' \
a.� hay aoa� ��
�^u
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
McKay-Hunter Hilis
Owner Name(s): Matthew&Michelle McKay Phone: - -
Owner Address: 10758N Hunter Hills; Hayward,WI Z�P; 54843
Project Address:
Govt.Lot: NW 1/4 of SW 1/4,Section 20 ,T 41 N-R 09 E❑or W Q✓
Township: Hayward County: Sawyer
Project Parcel ID#: 010-941-20 3205
Designer Information
Designer Name: Gerald Froemel Phone: �15 _558 _1138
DesignerAddress: 13502W Froemel Rd ; Hayward,WI Zip; 54843
E-mail: layfroemel@gmail.com
License Number: 950111
Remarks:
Signature:��/ "'"/'`" Date: 7-��-z 2
Original signature required on each submitted wpy.
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Calculations
I ft A 325 ft Basal Area Required 28125 ft`
K 1 ft B 50 ft Basal Area Pro osed 475 ftz
S 1.00ft L 52ft
W 9.50 ft
Basal Area Calculation GeoMat Dis ersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
450 1.6 gaVsq tuday 450 2.00 gaUsq tuday
Total 28125 ftZ Total 225 k2
Pro osed 325 ftZ
Number of Cells 2 GeoMat Width 325 ft
Cell Length ft Lineal Feet of GeoMat Required 69.2
Min. Cell Len th 34.6 ft Lineal Feet of GeoMat Pro osed 100
Cell S acin 1.00 ft NOTE:Min S dimension= 1'
S stem Elevation 88-83 ft
Limitin Factor 86J7 ft
Separation 2.06 ft 2�n�tin
Project:
I"�e 30, o� �/
End Connection Lateral Layout Diagram
�
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Hole spacing is every 12" , 1!2" hole at 4 & 8 O'clock, starting 4 O'clock 6"from end and �Jb7
:
S O'clock Holes at 12"from end. G t.�v � }y F��i
Laterai Spacing 3.00 ft Pipe Diameter 2.00 in
Distribution Cell Cross Section
91.1 ft � FinichrA rnAc �`7 ` `r Y � `!`7 Y
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d�Qr�. `� - _ � . _� �;a �___ ��^__ .
Rt���„��� op of geomat to be at o 1. .. _ _ _ _ _ . - . l . -- � GfA MAT
below original grade I I � I � I � 2.��33 �,,� 1 � I , I � I � I �
Infiltra�vc Surfsce
� _ _ _ � _NATIVESOIG. � � � � � �
� — � _ _ _ � _ _ � _ � � _ . t��pFecmr
52 ft y ,.r--
Observation Pipes
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91.1 ft F�°°°°r'°°°
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12" Min. , 4����
48" Max. �i�
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Project:
1� 9� 3b � < �/
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= 450 ypd; 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 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-it 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 ceRified 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: Gef2IC� Ff00171@I Phone: 715-55H-113S
�ooai 9o�e��me�c u��t: Sawyer County Zoning&Conservation pnone: 715-634-8288
Localgovernmentunitaddress: �Os�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.
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 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 county
��;;
'�o$ , ,, SYSTEMS Sawyer
p ( POWTS)
,�� s �
��kU�T`�_�..:A�.��.j.;
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 � �- I���
Personal infonnation you provide may be used for secondary pucposes[Privacy Law,s. I5.04(I)(m)]
Permit Holder's Name: ❑City ❑ Village �'Town of: State Plan Transaction ID#:
m a� d-{�(Cl^2�t� �C�,a N a l�a�f' �
insp BM Elev: BM Description: Parcel Tax No:
I�.C7 t F7a ���(^ 7w Si� c'�'� `�1�_ �� — (-[' � Oc0"' �.CO,�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �;S�k �,,,�Q�- �tX�p Benchmark �pp,p '
Dosing
Aeration Bidg. Sewer -
Holding St I Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet q,s,bg '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIRINTAKE
Septic +'�� �-�.5, �'f o k(p� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. qf�,33�
Holding Dist. Pipe qo,3S�
PUMP 1 SIPHON INFORMATION Infiltrative �'B3�
Surface �
Manufacturer Demand Final Grade
Model Number GPM �o C 33 ��$3�
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W �` � SoZ #of Cells Type of System Distribution Media Manufacturer:
(y� Conv ❑ Aggregate G�� �-
SETBACK OHWM of Nav a
P I L Bldg Well o IGP ❑ Chamber
INFORMATION Waters � AG � EZFIow Model Number:
CELL TO -�- �� �p' ^F-�� (�/ ❑ Mound � Other
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) I X Hole Size , X Hole Observation Pipes
Length Dia Length Dia Spac , Spacing ❑Yes ❑ No
- - — -- ' -- -- - --�I
SOIL COVER
-- - -
Depth Over Depth Over � Depth of Seeded/Sodded Mulched
Celi Center � Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
(J b7--O 12 '�-�7a l�2� _7 �02( �•�02
C,s.�S� �
� ,���rew.ewfi So;( ��SJ��-, a�� C�-��VI/i q+)
Plan revision re uired?�Yes � No ',b3 3 I II � 6
p ��.� �-- ��. I ����
_�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBER: _�-I �'I�____
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