HomeMy WebLinkAbout014-941-12-3409-SAN-2022-174 �
i:�Y=`�`"'.�:�, Industr}�Ser��ices Division County �
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�` 4822 Madison Yards Vda� J�� t%l� �
,`^`�S P �,� Madison, W I 5370� Sanitary Permit Number(to be filled in by C
`' � � ;'-- Y.O. I3ox 7162 �
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�� �-%" Madison. WI �3707-7162 �+i �j�� � (.� ��
\h�•�ritltl���t���'�� ('1 1
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Sa111ta1� PeY'1111t t�]�pllCat1011 State Transaction Number �
In accordance with SPS 38321(2).Wis.Adm.Code,submission of this form to thc appropriate govemmental unit �
is required prior to obtainina a sanitary permit.Note:Application forms for state-owncd POWTS are submitted to Project Address(if different than mailing ad< �
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privae��Law,s. I 5.04(I)(m),Sta[s. � � � ��� ���. � � ,�
I.Application Information-Please Print All Information
Propem�O��ner�s Name � Parccl#
� atl S 4t� G C - ✓ a � 3Ya�
Pr eRy wner's Mailing Address Property Location
�l/ Govt Lot
City,Stat Zip Code Phone Number
�l�iG�.� ���l''YI U{�lC� �� � ���� � � �— ��l ' /L�' -----'/o, _ '/y Section � �-
Il.Type of Building(check all that apply) Lot# T -/ � R_��_� o
�Ior2FamilyDwelline-NumberofBedrooms � � SubdivisionName �
[31ock#
❑ Public/Commercial-Describe Usc
❑City of
❑State Owned-Describe Usc CSM Number ❑ Village of
33 �S"�� �ti s�� �� �����,"�,����_ ; __ _
III.Type of POWTS Permit: (Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
�' �New S stem
y �� Keplacement System ❑ Othcr Modification to I?xistin2 Sy�stem(explain) U Additional Pretreatment Unit(explain)
B' ❑ Holdinc Tank In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design
❑ Other"I�ypc(cxplain)
conventional)
��• ❑ Renewal Before �� Revision ❑ Chan�e of Plumber ❑ "I ransfer to New Owner List Prcvious Permit Number and Date Issued
f:xpiration —
IV.Dispersal/Treatment Area and Tank Information:
Desian Flo�c(�!pd) Desi�n Soil Application Rate(<.tpd/st) Dispersal Area Required(st) Dispersal Area Proposed(s� System IJevation
Y.sv . � G y3 � Y� 9s o '
Capacity in Total #of Manufacturer
u
Gallons Gallons Units � c '� �
Tank Information � ^ J j
Ne�v Tanks Gsisting Tanks '� o — � � �
o —
c U :n � r ... Ci ._.
SepticorHolding�I�ank _�'�O� �(�� � �jL.�E�' �'On��p �
Dosing Chambcr
V.Responsibility Statement- l,the undersigned,assume re: nsibitit��fo installation of thc POWTS shown on the attached plans.
Plumber�s Name(Print) Plumbe(s S� �turc MP/h1PRS Number L3usiness Phone Number
�r �� � � � ..� �L�l �sas�y 7 S_�,•3�f_ �/76
Plumber's Address(Street,City,State,Zip Code)
� '�� ,� � S� - �f 7 7 � ,�Q.�� G�� S�'�y 3
VL C unty/Department Use Only
�Ap ro�ed ❑Disapproved Perniit Fee Date Issued Issuin�A�ent Si�nature
❑Owner Given Reason for Denial $ `W'� f� I'1'� �� �4%t�t�.JCX�.�>
Conditions of Approval/Reasons for Disapproval � ��-,,:---.;�
� p � '! � ��;'___._.
�11� ��`� D ate � �- �a- .,.� ,` `
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�s� a � — 1 � � �rtat#n�;�,_..._�� --�� saw�r�� c��.,f; ; .
.t. ✓11+ ZG�NING AG�MIf���.����-,,: i._ W
At[ach to complete plans for the system and submit to the County only on paper not less than 8 i�2 x I 1 inches in size
NO REFJNDS AFTER
sa�-639g�K.o3izi> ISSUE OF PE'f�MtT
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 I ndex & 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
Anderson
OWII@C N8f11@�S�; Equity Trust Co. Custodian FBO Michael C ANderson IRA phone: 651 _247 _ 7249
Owner Address: 620 Deere Dr, New Richmond WI Z;p: 54017
Project Address: 11324N US Hwy 63, Hayward WI 54843
Govt. Lot: 1 /4 of 1 /4, Section � 2 , T41 N-R 09 E ❑ or W ✓❑
Township: Lenroot County: Sawyer
Project Parcel ID #: 014941123406
Designer Information
Designer Name: Travls Butterfield Phone: 715 _634 _8176
Designer Address: 14346W State Rd 77, Hayward WI Z�p: 54843
E-mail: office@butterfielddrilling.com -_�i,�s ;}����t ,�s�t,��� f�„� �F,,,,�„��,� 5,�,,,,,�,.
License Number: 652879
Remarks:
.f
�
. ;�''/r
.�,
Signature: Date: 7/25/22
Original signature required on each submitted copy.
CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE.
� SOIL EVALUATION 0 Scale: 1so 60 go ,Zo � SYSTEM PAGE 2 OF `f
SITE MAP PLOT PLAN
PROJECT NAME: 152 pEsi�N F�ow: YS� GPD
re��.ti�'y Trsf Co• ��a���+h �� ►�ic��e� tn v�r"Sorl Attach design flow calculations for commercial plans.
PROJECT ADDRESS: I'��Y �0 3 N Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
^' C' w
/0 0.c� 'V Sanitary Sewer: l /
BM Symbol:� BM Elevation: FT �-
� Q � Force Main: /
BMDescription: I�Ri � �^ �� •'��
Indicate north by IMPORTANT:
Slope Gradient(%) Well Symbol(if applicable): � drawing an arrow Show ground elevation contours at suitable intervals.
of Tested Area: on the approprite line.
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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) �oo0 9al gal gal gal
Effluent Filter Manufacturer:
BeSt
I
Efriue�c Fuce�nnodei#: GF10-8
min.12"
SOIL COVER (typical)
12"
min trench
de pth
c�vP��a�� '. •�� TYPICAL TRENCH
- � • -� � ��°�:a� �•. CROSS SECTION VIEW
�(typc,sl)'• ..' �, .� ' . . �NO SCB�e�
w �• ' a
. • ' Provide minimum 3 ft
System Elevation —95•0 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap ObservationPipe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (typical)
Install per manufacturer's PLAN VIEW
instructions. �NO SCa�2�
� - -: ,� - - - - - - �� - - - - - - - �� - - - - - - - - - — �
� _
, . ; � � , I A= 3.Oft
�?; ; � , �tYPical) �
� — = - - - - - - - - - �f- - - - - - - - -��- - - - - - - - - =�� D
G�
�— B = �2a ft _ ( m
(rypical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typical) 0
(mfd by Infiltrator Systems,Inc.) �
Install pursuant to manufacturer's instruc`ions.
32 Quick4 Std-W @ 20 f� EISA/chamber= 640 ft` 'p
+ � Pairs of end caps @ 6 ft2 EISA/pair= 6 ftz
= Proposed EISA per trench = 646 ftz Required Infiltration Area = 643 ftz Distribution Method:
x � trenches = Proposed Total EISA = 646 ft2 branched manifold �
PAGE 4 OF 4
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 gpd; BODS<_220 mgL-'; TSS<_150 mgL-'; FOG<_30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
„ type of use
age of system
nuisance factors(i.e.odors,user complaints,etc.)
o mechanical malfuncfion(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 appurtenanoe(s)(i.e.,distribution/drop boxes)
o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,eic.)
o extent of panding in distribution cell prior to dosing
o dosing irregularities-if applicable(i.e.,pump re-cycling,float switch settings,etc.)
o elecVical components-if applicable(i.e.,wiring,connections,switches,controls,timers,alarms,etc.)
o dishibution 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: BUYt21f12Id IIIC Phone: 7156348176
Local government unit SeWyer COUllty Z011ltlg Phone: 7156348288
�oca�government unit address: �0610 Maitl St Ste 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,Wisa 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 submltted 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.
��="'=`""'-�""'i,. PRIVATE ONSITE WASTE TREATMENT county
������o$ ,�',, SYSTEMS SaWyer
������ �S� � ( POWTS)
�'`��r,_<�;s<��,
"-=� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� _ (? y
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] �
Permit Holder's Name: {�n. te. ❑City ❑ Village �Town of: State Plan Transaction ID#:
E v� �-3 1"�. �n���4�Q� l.e✓1��
Insp M EI v: BM Description: Parcel Tax No:
��.� � �a� l �. ��`` ;� �- o,y�aY�- �.�-����
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � �� Benchmark �p,�'
Dosing
Aeration Bldg. Sewer �7�S �
Holding St/Ht Inlet �17� 1��
TANK SETBACK INFORMATION St/Ht Outlet �6�4a '
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIRINTAKE
Septic NA � Dt Bottom
Dosing NA Instaliation
Contour
Aeration NA Header/Man. �, S-'
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface `?Sa�
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 � � #of Cells Type of System Distribution Media Manufacturer:
Conv o Aggregate <
SETBACK P/L Bltlg Well OHWM of Nav o IGP � Chamber I '
INFORMATION waters � AG � EZFIow Model Number:
CELL TO � ❑ Mound o Other
-- bs - a- 7�__
-------- --— —__ _Y� _
DISTRIBUTION SYSTEM X Pressure Systems Only
— - _ _____ — --- _
Header I Manifoid Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia__ Spac ' Spacing ❑Yes ❑ No
SOIL COVER
T -- --
( Depth Over Depth Over '�� Depth of Seeded!Sodded Mulched
� Cell Center Cell Edges I Topsoil__ _� ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies,persons present,etc.)
%�G-''"hSl�I lA� `�(�(��
Plan revision required?❑Yes❑ No �03���� I � � ���1 �
-----,��
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710{R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER:___����_��_
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