HomeMy WebLinkAbout026-939-27-5215-SAN-2022-151 ' Industry Services Division County �
4822 Madison Yards Way s0.w e � �
, �=P Madison,WI 53705 Sanitary Permit Number(to be filled in by Co.) �
= P.O. Box 7162 ,-.
Madison,WI 53707-7162 (,9 _3� � � � �
Sanitary Permit Application State Transaction Number �
� �
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriafe governmental unit —
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS aze submitted to Project Address(if difterent than mailing address) �
the Department of Safety 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. �ar�"� 1���Y »r`
I.Application Information-Please Print All Information
Property Owner's Name �a�n'+'�� A. � � � Parcel#
o, a
La� � s�-= �� '� �k o��- �39 -�� s��s�
Property Owner's Maili g Address Property Location
o J P� �
Govt.Loc
City,State Zip Code Phone Number
� �Section_�Z
Sa.,� � 1�'��l SS 37g
IL Type of Bu�lding(check all that apply) Lot# T 3g N R 9 Eo
^�1 or 2 Family Dwelling-Number of f3edrooms � � Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
�,�g 11 t� 11 O�1 0�,�,ot .SG+-►d G a /4,
v. S p- 39(. �
III.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 � Replacement System Other Modification to Existing System(explain) � Additional Pretreatment Unit(explain)
B' � Holding Tank In-Ground 0 At-Grade
� Mound 0 Individual Site Design Other Type(explain)
(conventional)
C• 0 Renewal Before Revision 0 Change of Plumber � Transfer to New Owner List Previous Permit Number and Date Issued
Expiration
IV.Dispersal/Treatment Area and Tank Information: ?ja(�;�K �/ �{,q�..js r S �+� � Stfs oL Gr•d S
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� Sys[em Elevation
yS`a o . � ��3 �S� � 9'-►. a U
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units � U �o � u
New Tat�ks Existing Tanks ` o a; L � " c� �y
� A
a. U �n �, v� u. C7 ci.
Septic or Holding Tank ' O�O �. I QL,� � w i C,��r' (A�CdY� x
Dosing Chamber
V.Responsibility Statement- 1,the undersigned,assume responsibility for installa6on of t6e POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Si naYure MP/MPRS Number Business Phone Number
�o-rata A s �eck.o s� 7�5 - - ti'7
Plumber's Address(Street, iry,State,7.ip Code)
9 aosN Sfu+c ��d �'T I�e� w�r�.r-c�, w r .Sz1e�/3
VI.Coun /Department Use Only
�,A�� ❑Disapproved Permit Fee Date Issued Issuing Agent SignaYure
❑Owner.Given Reason for Denial $��� •� � I � J �a`� ���'�'�R�i �"""`"�
Conditions of Approval/Reasons for Disapproval , D � , ����J�r r�,
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C S `�� � .!U L 0 7 2022
SAWYE� C0�IRITY
ZONING ADMiNISTRHTIOtV
Attach to complete plans for the system and submit ro the County only on paper not less thao A Irz x 11 inches in size
SBD-6398(R.03/21) NO RE�JNDS AFTER
19SUE OF PERM�T
PAGE 1 OF 4
In-Ground Gravity Plan
Index 8� Cover Sheet
Component Manual Design References:
Version 2-9,SBD-10705-P(N.01/01,R.10/12)
�,1 ?�•ay 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 Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report&Site Map
Project Name/Description
Hathaway Lodge- Ham Holly Dr
Owner Name(s�: Hathaway Lodge LLC Phone: - -
Owner Address: PO Box 432 ; Savage,MN ZiP; 55378
Project Address: Ham Holly Dr
Govt.Lot: 2 1/4 of 1/4,Section 27 ,T 39 N-R 09 E❑or W❑✓
Township: Sand Lake Counry: Sawyer
Project Parcel ID#: 026-939-27 5215
Designer Information
Designer Name: Ronald A Spreckels Jr Phone: �15 _558 _6472
Designer Address: 9205N State Road 27; Hayward,WI Z�P; 54843
E-maiL• ronspreckels@yahoo.com
License Number: 226688
Remarks:
Signature: //l��i'`� Date: rn/0 4/d 2
Original signa[ure q d on each submitted copy.
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Septic Tank(s)Manufacturer. �
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s)
3-ft Trench (down-sizing credit) �5o gal 9a� gal gat
Effluent Filter Manutacturer:
Lifetime Filter LLC
i
emue��F�ue�Modei n: LT-1/8
min.12"
SOIL COVER MPi�4
t2"
min,trenc�
depth
�Hai�si� � TYPICAL TRENCH
'.a . CROSS SECTION VIEW
��,yP,,� , (No Scale)
, " ..,
Provide minimum 3 ft
System Elevation = 94.00 {� separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap O�servatbn Plpe TYPICAL TRENCH
(typical) (Show location of inlet/ outlet pipe connection on plan view.) (�yc��0
Instanpermanutacwrers PLAN VIEW
Instmcllons. �NO .SCB�@�
� ._ _ _ _-- — _ _ J� — — _ _ _ — _ J� — _ _ __ _ �,�T#t ►�•R1111,
,.. ,� ,..,, / / '� .�.
�. n < � , fr ° ,� `a I A= 3.Oft
� � � �i��► Il#i�iF� (0'Plcap �
- - - - - - - - -�� - - - - - - - -�� - - - - — �
�-�— _ B = s� ft � —� m
(rypical) Quick4 Standard-W Chamber W
��YPlcal) O
INSTALL PER TRENCH: �mte by�oe�o-amrsystaros.�oo.� T
Install pursuant to manufacturefs instructions. �
�6 Quick4 Std-W @ 20 ft� EISA/chamber= 320 ft'
+ � Pairs of end caps @ 6 ft�EISAlpair= 6 ft'
= Proposed EISA per trench = 326 ft� Required Infiltration Area= 643 ft� Distribution Method:
x 2 trenches = Proposed Total EISA = 652 ft= 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 Oaeratinq Limits:
Design Flow = 450 ypd; BODS <_ 220 mgL"'; TSS <_ 150 mgL"'; FOG <_30 mgL''
Insnection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical maifunction (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, controis, timers, aiarms, 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. Disposai of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s)shail be inspected every 3 years and shail 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: ROf181d A Spf@Ck21S J� Phone: 715-558-6472
�ooai 9o�e��me�c ���t: Sawyer County Zoning & Conservation pnone: 715-634-8288
�oca� government unit address: 10610 Meir1 St, Sulte 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.
Continpencv 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 soi�s.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.