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Home My WebLink About010-841-36-5703-SAN-2022-164 � ,��:�-"=`L�:;,� Industry'Services Division County � - ��j� 4822 Madison Yards Way SaWyOf � ; ��5 ��' Madison. WI �370� Sanitary Permit Numher(to be filled in b�� . Pa �� ►�.a�3oX��02 `'��;4,, -- Maa��on.wi s3�o� �� 1 �� k� - - 4..� Sanitary Permit Application s�a`e T`a"sa°"°n"°_ee` ,_ In accordance with SPS 383 21(2).Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is required prior to obtainin�a sanitary permit.Note: Application fomis for state-o�cned POWTS are submitted to Project Address(if different than mailing � the Department of Safeh and Professional Sen�ices Personal information}�ou provide may be used for secondary �� +a�.��.� ��..� purposes in accordance�cith the Privac}°La�c,s- 1�_0-t(I)(m),Stats. �� L Applieation Information-Please Print All Information Property O�vner's Name Parcel# Zareena K Court 010-841-36-5703 Propert��O��ner's Mailing Address Property L.ocation 2700 Cove Cay Dr. Apt 1 E Go,,�°"� � City,State Zip Code Phone Nwnber Clearwater, FL 33760 _�___� Se��o„ 36 II.Type of Building(cheek all that apply) Lot# ��41 N R 08 E or W �I or2l�amily D�celling-�'umberofBedrooms� � SubdivisionName Block# �— �Public/Commercial-DescribeUse �Cityof__ _ _ �State Owmed-Descrihe Use CSM Number �Village of 19/89#5607 Lot 1 CSM 19/167#5649 �✓ ��n oi HayWafd_ II1.T}�pa of POWTS Permih(Check either"New"or"Replacemcnt"and other applicable on line A. Check one box on line B.Complete line C if a �licable.) `�� Ne�c S}�stem �Re lacement S s[�m �Other Modification to Existin S stem ex lain) �Additional Prctreatment Unit(e.� lain ✓ P )" ' ��Y � p P ) B' ❑Holding T'ank �In-Ground �At-Grade �Mound �Individual Site Desi�n Other Type(esplain) (conventional) C. Renewal Rcforc �Revision �Change of Plumber �ransfer to New Owner I.ist Previous Pennit riumber and Date Issued Expiration '� IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil l�pplication Ratc(gpd/sf) Dispersal Area Required(s� Dispersal Area Pro osed(st) S}�stem F'Ic�ation 900 0.7 1286 �'3 S� 94.00' Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units � a o '� � ?Jew Tanks E�isting Tanks 'Y � = Y � � � ._ U ✓: � n ... C� � Septic orllolding Tank 2�� 2�� 1 Wieser Concrete � � Dosinc Chamber � � � V.I2esponsibility Statement- I,the undersigned,assume ponsibility for i ta afion of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber'� ��nature MP/MPRS Numher Busincss Phnne Number Travis Butterfield �� 652879 715-634-8176 Plumber's Address(Street,City,State,7ip('ode) 14346W St. Rd. 77, Hayward, WI 54843 Vl.Coun �/Department Llse Only � 7 I� � Yermit I�ee Date Issued Issuing/�gent Si�iature Ap o d ❑Uisapproved � � ❑Owner Given Rcason tbr Dcnial $ ��^'-� ��'S��'� � -� ' Conditions of Approval/Reasons for Disapproval �-� �ti..�'��q��' i�:„ G U�� ( :�_?z,, �.�� ,.:.:,� , {—,, �ate �I�S��-� _____._� � ��,� �y � �� „ u JUl 11 2��Z ` r�G _ _ '� Chk#11Q� � � S� a-aZ — � � �� R�pt#Ne,w wvr t� �'�la 3i,' S�4WY�R COUi��Y �lf j ZpPJ�G F.Df�INISTR�:lO� �ttach to complete ans for the system and submit to the Counh�onlc on paper not Iess than 8 U2 z 1 I inehes in size NO REFJNDS AFTER seu-63�s�►z.ozizz> ISSUE OF PEAMIT PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Componenf Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) 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 Owner Name(s): ZAREENA K COURT Phone: - - Owner Address: 2700 COVE CAY DR APT 1 E, CLEARWATER, FL Z;p: 33760 Project Address: 9750N CARLSON LN , HAYWARD, WI 54843 Govt. Lot: 1 /4 of 1 /4, Section 36 , T41 N-R 08 E ❑ or W ✓❑ Township: HAYWARD County: SAWYER Project Parcel ID #: 010-841 -36-5703 Designer Information Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176 Designer Address: 14346W ST. RD 77, HAYWARD, WI Zip: 54843 E-mail: OFFICE@BUTTERFIELDDRILLING.COM I��,,, ;�,�,�� ,�,�r,-�d ��F� a��,��, s�� ,��w�,,,�. License Number: 652879 Remarks: Signature: Date: � � � — �� Original signature required on each submitted copy. CHECK BOX AS APPLICA6LE. CHt=CK BOX AS APPLICABLE. � SOIL EVALUATION 0 Scale: 1so 60 90 �zo � SYSTEM PAGE 2 OF �I SITE MAP PLOT PLAN PROJECT NAME: 9� ,15s DESIGN FLOW, GPD Za/�e/�a C�u�� Attach design flow caiculations for commercial plans. PRo.IECT ADDREss: Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5) / N Sanitary Sewer' �� "Y BM Symbol; � BM Elevatian: / �� '� FT � / Force Main. / BM Description; �6�` �'� f 8 u ��K � Slo e Gradient %) Indicate north by IMPORTANT: P � Weu Symbol(if applicable): � drawin9 an arrow Show ground elevation contours at suitable intervals. of Tested A�ea', on the approprite Ilne. �L '�oo `� �� `Sor �\ � \" � �� . 3 t - P�L /ob� � —� �atr-Pl�ii.a �� (� �jln� — /oO.c� �lQ-�� l�4D/�'�c. � 7017 Cav2r l�a.�. {1�' /¢� �� , !��O C��w�- � f{ 3? ��d a� q �o F" r�f�. �,�r�i 3� 9�..5 Tw.� . Y L � �� W 1'rfa' Gd.�c� ✓'�f� 5� 3� TYINRa6 W Go��-, �f � ��, �� p�,s ��,.ti�- �pS lc ��fer— Sys/�h- .�L. 9�� ',�,,,,�S �.�,�e�--�� n�PRs -� �sa87� 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) 200o gal gal gal gal Effluent Filter Manufacturer: B@St I Efriue�t F�ice�Modei�: GF10-8 min.12" (typical) SOIL COVER i z" min.trench depth criP��a�� ' < � TYPICAL TRENCH - - - - - � . -•� �� °�.a� �<. CROSS SECTION VIEW � 34„ �'� .. , • <<YP;�a�� :�, �° . . (No Scale) .r �• ' a . ° Provide minimum 3 ft System Elevation — 94.00 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap Observation Pipe TYPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (rypical) Install per manufacturers PLAN VIEW instructions. (No Scale) � - - - - - - - - - - ��-- - - - - - - - �f- - - - - - - - - � �;��,'� � ' q t, i' , � � ��, ,� � � � �A= 3.0 ft � ��YPical) � � - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - -J D G� �- B = 88 ft - I rn (typical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typicaq � (mfd by Infiltrator Systems,Inc.) � Install pursuant to manufacturers instructions. � 22 Quick4 Std-W @ 20 f� EISA/chamber= 440 ft� + � Pairs of end caps @ 6 ft�EISA/pair= 6 ftz = Proposed EISA pertrench = 446 ft2 Required Infiltration Area= 1286 ftz Distribution Method: x 3 trenches = Proposed Total EISA = 1338 ftz branched manifold � ..�T 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 = 900 gpd; BODS 5 220 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 - if applicable (i.e., wiring, connections, switches, coritrols, 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 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 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: BUtt2tfl@ICI, IIIC. Phone: 715-634-8176 �ocal government unit: SaWyer COUllty ZOCllllg Phone: 715-634-8288 _ �oca� government unit address: 10610 Main St. Suite 49, Hayward, WI Z1P: 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. Continqency 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. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. ""'"f` PRIVATE ONSITE WASTE TREATMENT county '., ,> �'��o$ SYSTEMS ,�� PS ,� ( POWTS) SaVV�eT �R�F�—F�'/, �x''�"��'' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 2a _ �(oy 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#: �t'�v�a L�o�.C� a�(war� " Insp BM Elev: BM Description: Parcel Tax No: loa�o' Iva,\ ��, ��"�� -�s— a�� -8Yr�36- s`7G3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,,; q�� Benchmark (rx�.p� Dosing Aeration Bidg. Sewer �6 p' Holding St/Ht Inlet �3S TANK SETBACK INFORMATION St/Ht Outlet qs-�S� TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet AIR INTAKE Septic 5� N /� �o� .�..�o� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. �,�� Holding Dist.Pipe PUMP 1 SIPHON INFORMATION Infiltrative � Surface `�3.° 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 ,�� L g0 �-` q � #of Celis Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �,�I INFORMATION P I L Bidg Well Waters o GP � Chamber Model Number: ' ❑ EZFIow CELL TO -�-oLs N -FS"D ❑ Mound o Other �� — - - ----- - -- -- --- - -- DISTRIBUTION SYSTEM X Pressure Systems Only --__ _- -- __ ____--- -- -- Header I Manifold Distribution Pipe(s) ' X Hole Size ; X Hole Observation Pipes� Length Dia _ Length Dia Spac 'i Spacing ❑Yes ❑ No - -- — SOIL COVER - - — - Depth Over Depth Over � Depth of � Seeded/Sodded Mulched f Cell Center Cell Edges Topsoil_ ___ � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ��,�(��I �z l� I� r-�-- `--- �_ __ _ _ Plan revision required?❑Yes❑ No 'b3 '', �3 �.� I, � �e�'� � � � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A��ITI�NAL COMMENTS AN� SKETCH SANITARY PERMIT Nl1MBER__,_�_��___. 23� �� 3� � �+ I � � � � i � � ��. I, . . �� , �� - � ,o- w.�- fi2s ' �'`r° \ � ��a�fi \ .T �r Jf � /3' � �j3� � �`�" e�� W P� �1 � Ga� � —�v--- �� s� ��'-_�— �'� Ca�1�^ ��—