HomeMy WebLinkAbout028-642-26-5404-SAN-2022-165 c./?
` Industry Services Division Counry �
4822 Madison Yards Way Sawyer
- ,_' - Madison,WI 53705 Sanitary Permit Number(to be tilled in by( . �
= P.O.Box 7302
" Madison,WI 53707 � �� � � ( �
�
Sanitary Permit Application State Transaction Number �
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit �
is required prior to obtaining a sanitary permiL Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a< ��
the Department of Safety and Professional Services.Personal information you provide may be used for secondary TBD - Cam Rd
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. p
I.Application Information-Please Print All Information
Property Ownefs Name Parcel!!
John G Hilpisch 028642265404
Property Owner's Mailing Address Property Location
12667 40th ST. N Govt Lot 4
City,State 7.ip Code Phone Number
Stillwater, M N 55082 651-261-0067 �%, '/., Section 26
II.Type of Building(check all that apply) Lot# r 42 N R 06 E or
�I or 2 Family Dwelling-Number ofBedrooms 2 7 Subdivision Name
Block#
❑Public/Commercial-Describe Use
�City of
�State Owned-Describe Use CSM Number Village of
11/76 #2340 ❑✓Town of Spider Lake
III.Type of POWTS Permit: (Check either"New"or"ReplacemenY'and other applicable on line A. Check one boz on line B.Complete line C if
a licable.
`� ew S stem Re lacement S stem Other Moditication to Existin S stem ex lain Additional Pretreatment Unit(ex lain
✓�`i � Y � P Y � S Y ( •P ) ❑ P )
B' ❑Holding"I'ank �In-Ground �At-Grade �Mound Individual Site Design Other Type(explain)
(conventional)
C• ❑Renewal Before �Revision �Chang�of Plumber �Cransfer to New Owmer List Previous Permit Number and Date Issued
Expiration NA
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
300 0.7 429 450 99.43 6�Sh�<<u�
Capaciry in Total #of Manufacturer
Tank[nformation Gallons Gallons Uniks � � o ,�, �
New Tanks Existing Tanks �� � � ` Y � � �
0
G U cn v, v� [r. C7 0..
Septic or Holding Tank 750 750 1 Wieser �
Dosin�;Chamber
� � �
V.Responsibility Statement- [,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumbers Name(Print) Plumber's Signature MP/N1PRS Number Qusiness Phone Numbcr
Jason Kuettel 675751 715-798-3355
Plumber's Address(Street,City,State,Zip Code)
PO Box 66 Cable, WI 54821
VI.County/Department Use Only
�.4 �r ed'� ❑Disapproved Permit Fee Date[ssued lssuing.Agent Si nahi e _
�/ + ,� ��� (��� . �
�� ❑O��ner Given Reason for Denial $ l�'� �I���;�� rl�j'�"`T"'� �:�r .—,r,��
- c �
Conditions f ApprovaVReasons for Di approval i� 'J _'•":,,.-,•;;;.�'r �Jt '�•�";, ,f
�S T �a" ��� � � ''�t r-'_.____--__=____—_.; ;; :{
;�te 7 a_ � ]� � � J�L 1 1 �� ` � �,;
:=nk# �3t�o 22 �-,.
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:� 11� ' � , �_��`�'��'�t'-; C;:,�.�};`�;-��
'�_C�4t#��'C.U1 �/l�or�d �'c�Co 7�ZOi�1iN(a Fi�P,;1;"ri�Ti�RTI�N
�,5��- � �C ,�-�
Attach to complete plans for the system and submi[to Ihe County only on paper not less[han S V2 x 11 inches in size
ss�-639a�R.oaizz� NO REF'JNDS AFTER
18SUE OF PEAMI7
�H ���'3 I"7
PAGE 1 OF 4
In-Ground Gravity Plan
Index � Cover Sheet
Component Manual Design References:
Version 2�, SBD-10705-P (N.01/01, R. 10/12)_ ..
<' `
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
Hilpisch - 2 Bedroom Septic
Owner Name(s): John G Hilpisch Phone: 651 _261 _0067
Owner Address: 12667 40th St. Stillwater, MN Zip: 55082
Project Address: TBD
Govt. Lot: 4 1/4 of 1/4, Section 26 , T 42 N-R 06 E❑or W �✓
Township: Spider Lake County: Sawyer
Project Parcel ID #: 028642265404
Designer Information
DesignerName: �asonKuettel Phone: �15 _798 _3355
Designer Address: PO Box 66. Cable, WI Z�p; 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Signature: Date: > �� z�TL
Original sign r required on each submitted copy.
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MP 6-�5�s �
7/ii �7.e22
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
� � � � � � � ��
� m��.iz•
Geotex�ile � �NP;�,� TYPICAL TRENCH
Caver
SOILCOVER CROSS SECTION VIEW
�2- (No Scale) OBSERVATION PIPE DETAIL
min.trench ;
tlepN I (No Scale)
(�ypical) L — r - - "��',:: Screw-Type or Finishetl Graae
SfipCepQoose) ♦ •�'°' � (mulched&see0e0j
e ; :
System Elevation/99•43 t� • •�.� ' 4"0 PVC Pipe '�� roPso�co�a,
' � Provideminimum3ft Topolpipe�otertninale (�^�^�����)
(typicaq at or abave OnisneE gade
separation between trenches.
(4)1/4"-1/z"X 8"Sbts
@�O aoen
i.'.
TYPI CAL TRENCH (Show loca[ion of inlet/outlet pipe connection on plan view.) a„�no��9�„� i�i;n,���
PLAN VIEW Su�d�
(No Scale) 4n� Observationpipeshallbeinstalled
a�jundion betwean two uni�s. '�O n
Perforated Lateral Observation Pipe
— (typical) (typicaq — — (�vP�cap
�f- - - - - - - - - - - -- ��
�- - - - - - - --- - �
� ___==_' _______ =--=- _= =__ _______ ____-__= � A— 3.0 ft D
� - - -- - - - - - - - - -- �f- - -- - - - - - - - - - --- - � _ cryv���� G�
�-. g= 45 ft �; m
��vPi�aq W
INSTALL PER TRENCH: EZ1203H Bundle �
(typical) �
4 10-ft bundles @ 50 fl� EISA/unit=200 ft' (mfd by�nfi�traror Systems,Inc.) �
Install pursuant to manufacturefs instructions.
+ � 5-ft bundles @ 25 ft� EISA/unit= 25 ft'
= Proposed EISA per trench= 225 ft� Required Infiltration Area= 429 ft' DiStfibUtiOn MethOd:
x Z trenches = Proposed Total EISA = 450 ft= branched manifold
RESET .r
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 Operetinq Limits:
Design Flow = 300 gpd; 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- if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure- compare to design specifcation)
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: Afldfy R8SITIUSS@Il & SOfIS, Inc phone: 715-798-3355
Local government unit: SBwyer COUnty ZOning Phone: 715-634-8288
�oca� government unit address: 10610 Main St. #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 depaRment 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 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.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
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