HomeMy WebLinkAbout012-739-06-1302-SAN-2022-172 �
_"`""' Department of Safety c°"°ry lJ—
s � - J� &Professional Services, �W e �
; . :'_ -. ��•,► ��JI Sani�ary Pemtit Number(�o be filled in by C
'� ��� IndustryServicesDivision
(A/�' �9'��I i l� ;� �
Sanitary Permit Application StareTansactionNumber P�
In accordance with SI'S 383.21(2),Wis.Adm.Code,submission of this form w the appmpriate govermnental mit
is required prior to obtaining a sanitary permit Note:Application fortns for stateowned POW"f5 are submitted to Project Address(if diBerent than mailing ad �
the Deparhncnt of Safety aod PmFessional Scrvices.Personal information you provide may be used for secondary p� �
purposes iv accordance with the Privacy Law,s.15.04(q(m),Stats. � '
LApplicationlnformation-PleasePrintAlllnforma0on � ( k<.khern
Property Owner's Nam Pa c# -�'J�d-�
eZo,�.e.s �r h ola-?31�o(o-Wao
Propeny Owmer's Mailing nddress r�n�rcY i,o�;ai�o� p 7
r�s,s �aa��Q st S� N�
Ciry,State Zip Cale Phone Number �'
�lea.swr� �ra,�;e � 5315£3 a6a,9�lS-8`i9a ��w1 �,5 F ,.s�tio� �a
II.Type of Building(check all that spply) � Loc tt T J l N R E o
❑I or 2 Family Dwelling-Number of Aedrooms Subdivision Name
Block#
❑PobliclCommercial-Dacribe Use
❑Ciry of _
❑StatcOwned-DescribcUsc CSMNumber ii �Villageof __
i�To�or N•J.n-�er _
III.Type of POWTS Permit:(Check either"New"or"Replacemen[^and other applicable on tlne A.Check one bos on line B.Compiete line C i
a licable.
`*� ❑New System �,Replacement System ❑Other Modification to Existing Syscem(explain) ❑Addirional Pretreatment Unit(explain)
B' ❑Holding Tank �,In-0mund ❑AaGrade ❑Mound ❑Individual Site Design ❑Other Type(explain)
(comentional)
C. ❑Rrnewal Before ❑R�wision ❑Changc ofPlumber ❑Transferto New Oumer �st Previous Ycem1it'Number aod Datc Issucd
Expiretion �AN K. �
IV.DispersaVTreatment Area and Tank information: � �j GBI S f 3, EZ I�W �..,n:
Design Flow(gpd) Design Soil Application Rzte(gpd/s� Dispersal Arca Required(s� Dispersai Arca Pmposed(s� System Elevation
Yst� .? 6�l3 67S 93.�'
Capacity in Tohel q of Manufacturcr
Tank Infortnxeon Gallons Crallons Units �v 9 y .�
NewTenks FxisengTenks � � U y d .<'' A
a`V - .2, in �iU a
SepticorHoldingTank X t OD� � SK4N fG
Dosing Chambcr
V.Respousibility Statemen[-1,the uudersigued,essume responsibtity for imfalletion of the POWTS showu on the ettached plans.
Plumber's Name(Priny Plumb s Signamre MP/MPRS Number Business Phone Number
Cr ' �a .�n �✓t dao 7t5 a66-a��+
Plumbc�s A ross(StrroC Ciry,State,Zip Codc)
So� -N �.o ��-�er l�c�� S`l S
VL Coun 1/Department Use Only
�Ap ro tl ❑Disappmved aertnit Fee � Da�e Issued Issuing Agrn[Signature
❑Owner Given Reason f r[knial 1�' �I��I� �"-""�^'�"'
Conditions of ApprovaVReasons for Disapproval C�����S?57��
,�,: i��r
����I � � )ate �7�Zq��-� _ !�
���� ::hka_ C�s�I = ; JUL 25 2022 ;—�
CCS j a�-31� ;���,t n��;,.� �.,���a�a�i� ;- ,�;.—,_��
�,�,,� Zl?viNii 4�MitViSTRAI-IOiV
Aroch b campk�e pbm far t6e syflem�ed eubmk to the Couoly only ov paper vol Irn Nav 8 t/Z x II ineAea io siu
se�-�s9s�e.o3izz� NO REFUNDS AFI'ER
ISSUE OF P�RMIT
,nN`� 1�I l��I I
� PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component 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): `1 olr�� �rc�+� Phone:a�oo1 -��-�
OwnerAddress: 1�515 /o1dn�,Q St P1Ca5a�Lt ��a.r�c Zip: s�l$'9'�c
Project Address: 7a�7'N C�uc.klnorn RtlC
lj 1� N E �}- 1� 1� 1/4 of�1/4, Section��, T�_N-R�_E Q or W �
Township: }-�t�,11'��!' County: 5 aW�er
Project Parcel ID#: ��oZ' �3�'( ' fl(o - 13oa�- waoy
Designer Information
Designer Name: � c� .s� Phone:7�-� - �o
Designer Address: s g -N Tha� �n R �i�� Zip: st� ��
E-mail: uc.0(Y'�'�a � G[�i ���e. Ca� ,
License Number: o2pZ� ��c7
Remarks:
Signature: ' Date: � � - ao2
Original i nature required n each submitted copy.
CHECK BOX AS APGLICABLE CHECK 80X AS APPLICABLE.
� SOIL EVALUATION o s��:�ao� � $o �SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN /
PROJECTNAME: oesicNF�ow: LLS� cPo
T 7a'
J i f� P ru-�h ( Attach design flow calculations for commercial plans.
PROJECT ADDRESS: ���7�N lJ�U-k�y7f�1 I�V Pipe Matenal/ASTM Slandard(Tables 3&1.343 8 384.30-5)
lo l�aa FT N 5a��ary�we, y„ , p��
BM Symbol:�- BM Elevalion: Forre Main: /
BMDescnp�ion: �OP �� l.��ll
sio e�radient[/) ��a��a�eanahrro, IMPORTANT:
of Tested Area: � Well SYmEd(if applicable): p drewi�q Show gmund elevatlon contours a�suitable intervals.
on t�e aOProprlle line.
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s) nufacturec '
rJ �.aw �r e e4.�'E
Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s)Volume(s)
3-ft Trench (down-sizing credit)
�gal gal gal gal
EHluent Filt nufacNrec
BeS-E. �s� 1o'�S
Geotextile I min.12" Effluent Filter Model#:
covar � (NPicaq
SOILCOVER TYPICAL TRENCH
min.trench-{ ; . CROSS SECTION VIEW
aePm j L (No Scale)
�HP"a�� —T •�,' � . OBSERVATION PIPE DETAIL
�p � >.'; (Hos��i
System Elevation = (3.fl ft. �• � sGa"'-ryPa°` F�msneacaaa
(bPical)
� ' Provideminimum3ft siiPCappoose) �mu�chae8seeaed)
SEP8f8tlOf1 b2tWBBf1 tfBllChBS. a^BPVCPipe _ TovsoiiCover
Topofplpe�o�ertninale (min.lfool)
at or a�ove finishetl gratle
(4)1l4"-tl 'X 6"Slots
TYPI CAL TRENCH (Show location of infet/outlet pipe connection on plan view.) �9�ePen
PLAN VIEW "^�^�^°9°�°� �°°°�"°^
4��� Observation pipe shall be inahalletl $udacB
(No Scale) atjunctionbelweaniwounits. S ft
Perforated Lateral Observation Pipe
— (typical) (�YP��O — — (typical)
r - - - - - - - - - - �� - - - - - - - - - - - - - -F-_�� �
I °°_°__ _______ _--__ I a,- a.o n D^
__ °°_ _____°_ ________ -
— — — — —� (�YPiral) 1` ,
� - - - - - - - - - - - - - - - �� - - - - - - - - - - - - - - — rn
' - a = �1S ft �I w
�ryP��o
INSTALL PER TRENCH: EZ1203H Bundle �
(typical) �
�� 10-ft bundies @ 50 ft� EISA/unit= aOD ft� (mid by Infiltreta Systems, Inc.)
Install pursuant to manufacturers instructlons.
+ ' 5-ft bundles @ 25 fl� EISA/unit= aS ft'
= Proposed EISA per trench= a°ZS ft' Required Infiltration Area= �_IJ ft' Distribution Method:
x 3 trenches = Proposed Totai EISA = 6� n' l'S f�.��'�!
�
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 Ooeretinq Limits:
Design Flow= yJ� C'� gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL"'; FOG <_30 mgL''
Insqection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user compiaints, 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 capacifies, prohibited activiGes, etc.)
o extent of ponding in distribution celi priorto 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 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 tankls)shall be pumped by a certifed 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 Iiquid 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) shali 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: �On�omPson a- SanS ��c. LLC Phone: ��oZ.�o—o��$�a
Local government unit: JRWY°✓ CoKn'E� LO/�i M Phone: 7I S'�3K� £Sol�
Localgovernmentunitaddress: 10�0 ���n 5�, S�-t�+G.-i / 17A�4��C ZIP: J�����3
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 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 P01NTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
State of Wisconsin
DEPARTMENT OF NATURAL RESOURCES Tony Evers, Governor
101 S. Webster Street
Box 7921 Preston D. Cole, Secretary
Madison WI 53707-7921 Telephone 608-266-2621
Toll Free 1-888-936-7463 W�SCONSiN
TTY Access via relay - 711 DEPT.DF NATURAL RESOURCES
��J�f lu �� '�r1�. ��.�- 5�
July 28, 2022 ' ��'r����,J„� ����`�,�
��� --' �� �
JUL `�
Sawyer County Zoning and Conservation Deparhnent 2 8 Z�ZZ
10610 Main Street, Suite 49 `�•�'✓1`ER
Haywacd WI 54843 ������ COUNTY
AUNN;yfS7RATfOry
Dear Sawyer County Zoning and Conservation Department:
I have reviewed the information for 7083 N Buckhorn Rd in the Town of Hunter, Sawyer County, Wisconsin. The
property is further identified as having Sawyer County Tax ID #14659.
This propeiTy is not covered by a Chippewa Flowage buffer zone restriction.
All othcr county and state codes and permits apply to the subject property and must be applied for and adhered to.
Please contact me if you have any questions.
Sincerely,
C����2
Roy Kenast
Chippewa Flowage Park Manager
715-416-1061 �
dnr.wi.gov ���„„�o
wisconsin.gov Nc�rurally WISCONSIN °"AEc"£`
PAPEa
��•'"''`"E,� PRIVATE ONSITE WASTE TREATMENT county
,.� �,
��_/� ;.�,
�� ��o -; SYSTEMS
� �S�S ( POWTS) Sawyer
� �` �— _��
�`°`x"��'����� INSPECTION REPORT Sanitary Permit No:
\:_ � ��
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� � I � �
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#:
�s �, N�,�,-�-�— �
Insp BM Elev: BM Description: Parcel Tax No:
�\ r [J r/
`W �'D f� b�LA1"e�` ' � I� r�J �.� �p "' -i �U 7
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic tn/ �p Benchmark �� o r
Dosing
Aeration Bltlg. Sewer q��
Holding St / Ht Inlet 9.S' Y r
TANK SETBACK INFORMATION St l Ht outlet �'i s'.� �? '
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic h�o t,2s� �(, � �-(, � NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header / Man. �� �.6 �
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 INFORM TION
DIMENSIONS W ,3 L � �(� � # of Ceils.3 Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
P / L Bltlg Well ❑ IGP ❑ Chamber
INFORMATION Waters � AG Q9► EZFIow Model Number:
CELL TO ��j� �t'$?> fi- ' � ` ❑ Mound �o Other
DISTRIBUTION SYSTEM X Pressure Systems Oniy
Header / Manrfold Distribution Pipe(s) ! X Hole Size X Hole Observation Pipes
Length Dia � Length Dia Spac � , Spacing ❑ Yes ❑ No _
SOIL COVER
Depth Over f Depth Over I Depth of � Seeded / Sodded �Mulched �
Cell Center � Cell Edges ' Topsoil _ _ ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
��5� �� 9�(2 ��
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Plan revision required?� Yes 0 No �3 03 �Ja � II � w J �� � f�
�--- - �c:���--_---
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710 (R.3/01)
AODITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NLIMBER:_ �� -L`��___
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