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Home My WebLink About010-171-00-0802-SAN-2022-203 _-;�` " Department of Safety �°°"�' SU wyer � - \ � /�=_, & Professional Services, � - � : Sanitary Permit Number(to be filled in by ��, �= r Industry Services Division ' i� 3a � q3 � State Transaction Number � Sanitary Permit Application _ � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS aze 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 purposes in accordance with the Privacy I.,aw,s. 15.04(1)(m),Stats. � 1 g 23G/ 7G/1�`�tyf.� r� I.Application Information-Please Print All Information Property Owners Name Pazcel# ��-�n'�l�, Cor,�llo c�l� , ►�� -. oo- o s�Z Property Owner's Mailing Address Property Location �� ox �S'6 � re��.�s�--. City,State Zip Code Phone Number �� /h�.C��.en , �x ,5��(0 0 /j�S,��Section II.Type of Building(check all that apply) � �ot# 'C �r N R �g E or �r2FamilyDwelling-NumberofBedrooms �� Lo-}- g SubdivisionName B ock H Q r �Public/Commercial-Describe Use '"' ❑City of ❑State Owned-Describe Use CSM Number O Village of r-- �'f'own of ��y WN' IIt.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 L�New System �Replacement System _ Other Modification to Existing System(explain) � Additional Pretreatment Unit(explain) B' ❑ Holding Tank �In-Ground ❑ At-Grade ❑ Mound � Individual Site Design ❑ Other Type(explain) (conventional) C• ❑ Renewal Before n Revision ❑ Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and DaYe Issued Expiralion L�In K. ( IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation ��'o . � �d �r 1 i zS 9m � �� Capacity in Total #of Manufacturer � Tank Information Gallons Gallons Units � U U $ � ^ New Tanks Existing Tanks ` o p; � y �' c� "� a U 'v� �, v� (.�. C7 a Septic or Holding Tank �u S LGs ' ��L,j�,/ Dosing Chamber V.Responsibility Statement- I,the undersigoed,assume responsibility for installation of t6e POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number � [G., 5��1� �srl�i 2 ��.�-_ rt�g_,r��Y Plumber's Address(Str et,City,State,Zip Code) 1a7GN S�dn� ��.k� �� S�` �wt�v Wr �S�fd7fi VI.County/Department Use Only y� Permit Fee Date Issued Issuing Agent Signature l�A d ❑Disapproved y ( �� Q�� ❑Owner Given Reason for Denial $ I�� I ��"1 a a �i�,�." Conditions of Appro'val/Reasons for Disapproval :-. -- .-,--- ,� G�Bt�_��.�.a��'� . � i..? r JI ^ � t5 `�/ �t�i 1 , �� } I � � W� ' hk# _.. 3S , �� C _ .._..�,...� ___.. � � AUG 1 2 2022 C�� p� — I �3 �-i�'�''°�IQ�U�_�.�LO SAWYER COUN"i�Y ZONWG ADMINISTRATION Attach to complete plans for the system aod subroit to the County ooly on paper oot less than 8 tn x 11 inches in size NO REFJNDS AFTER SBD-6398(R.03/22) ISSl1E OF PE�IMIT PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design Reterences: 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): �a�"� �°S��o Phone: - - Owner Address: �� °x y5 6 7 , �ts.�/c�, {�x Zip:�� S' �� ProjectAddress: �ZS?23� '"�+�n�al�, �� Govt. Lot: 1/4 of 1/4, Section 2 � , T �// N-R �� E❑or W� Townshlp: �W Q� �Nr w"'� County: Sawy� Project Parcel ID#: blo _ I Z— oa -- e g n2 Designer Information Designer Name: Dylan Schultz Phone: ��5 _ 558 _ 5904 Designer Address: �076N Stone Lake RD Z�p; 54876 E-ma��: C�y�111SC�'IU�tZ18�gffldl�.00111 "7�I1�sspacereservedforapprovaLstamp. License Number: 1516129 Remarks: Signature: Date: � � � - � � O' inal sgnatur uired on each submitted copy. p(��- �(�,� owv�eu-s: L�, P4�ri�tL CoS+e��n� k.a�tec,he J��'��. S�w�e� Co.� �yw�.-1 Tw� �0 8x �sb� P�� 0�0 - �71-00 - osoz. N(� G4tle�n , T�c 5�{(,�o S' z3 T '� � r.1 R D8W 4lZ — Z�-(�S— 55'f(o Ro�� Lake Parl�- I�f' 8 �✓"•�E: � ZCj Z3 �.t� S QN�✓��i�4 �Ci .tid a-l�e'" _l-74 � � ti �°� � �-' ,�� —' s�e¢� _\ T / Jef� / \ � /, �' � , �I p r 3 , s b� � 3 E-Z �5 ° Z SCor�. Pr�t Sc-We ��=�{D� � �UIQ(( � e �v so �o k0 � �se gy��no z • � r� B C �� DaY no,at �~`Je 9 Dylan Schufiz � 7076N Stone Lake Rd � �,� Stone Lake, WI 54876 MPRS 1516129 ol� Conve�te� C46�� r j� SI�.gS L.OG4 r.Ov�E StZe �Q�rJCOj� • �c �. Bt'� too'� na<<,r� bbo.1 z�l��vP W �,�.e 28'D�k. �� B 1. 9`t.s' a. 4�.z' 3 3. Rs.z' N ,� So-�5� S��e�N �Z � (Jr4r�e 40' -43 � � �. �st. sT ,-� l�k 94' � _..._ SePticT�a�n��Sea�acturec IN-GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundtes SepticTank(s)Vdume(s): 3-ft Trench (down-sizing credit) I�G� gal gal gal gal Effluent Filter Manufacturer � ,e_>_e�. (�Jtl��. �oO� I min.12' EftluentFilterModel#: �"" J �Y Geotextile I (typiwl) Cover SOILCOVER TYPICAL TRENCH 'r CROSS SECTION VIEW min.Venc� � . depth �typ;�i� �- — — -�",. . ;; (No Scale) OBSERVATION PIPE DETAIL p `�: : �No sm�, System Elevation= ( � ft. � ' s"a"'-Ty°a°` • Slip Cap(loose) �^'r' , Finishatl Grade �ryPi�� • Provide minimum 3 ft �m��,aa a��a�a� separation between trenches. a•e wc P�� Topsoil Carer TOPolpipetotertninata �'� (min.lfooQ at or above finieheG grdde (4)1 k'-t X 6"Sbts TYPI CAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) ��aaan >�. PLAN VIEW AnchanngDeviw ��n�ro� 4n � Observation pipe shall be inslalleC Su�face (NO SC81@) Perforated Lateral �iu��u�� ft Observation Pipe �N��) (typical) (rya��aq - - �� - - - - - - -- - - - - - - - — r - - - -- -- - - - - - - - - � I °__'__ __'____ '--'= I A— 3.0 ft � __ '__ _______ °__'__'_ — L - - - - -- -- - - -- - - - �f- -- - - - - -- - - - -- - - - - - J (�vr��) � m i= B = ft �i �,,� (Ha��9 INSTALL PER TRENCH: EZ1203H Bundle � 7 3So taP��p � 10-ft bundles @ 50 ft� EISAlunit— ft' (mfd by In9ltrator Systems, Inc.) Install pursuant to manufacturer's insWcdons. + � 5-fl bundles @ 25 ft EISAlunit= � ft' = Proposed EISA per trench= 3 7� ft' Required Infiltration Area= 107( ft' Distribution Method: x 3 trenches = Proposed Total EISA = �12� ft' G'""�'y � 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 pertormed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operatins� Limits: Design Flow= �� 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, eta) 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 disiribution 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 specification) o surtace discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Seotic 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 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)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 Wlsc. Admin. Code. Report any component fallure or malfunctfon to: Dylan Schultz 715-558-5904 Name of individual or company: Phone: Local government unit: SBwyer County zoning Phone: �15-634-8288 10610 Main Street, Hayward, WI 54843 Local government unit address: ZIP: 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. Continaencv 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. '""'`` PRIVATE ONSITE WASTE TREATMENT county �` � � ,��`�;�� SYSTEMS SaW er �;� � o$ ��'; `�� $ �� ( POWTS) Y \�\T`�.i��%`T`/ INSPECTION REPORT Sanitary Permit No: Safety and Buiidings Division (ATTACH TO PERMIT) GENERAL INFORMATION �Z� _ dLp3 Personal infonnation you provide may bc used for secondary purposes[Privacy Law,s. L5.04(1)(m)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Tra�saction ID#: Y.l�i c Y C,GISi'�--l lb �q�wct� �— ♦ Insp BM Elev: BM Description: Parcel Tax No: (oo��' �u.�1 r:bl�o�, �y"., w. s.� �-�`' o4k o�o �c�t- oo- b�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � � Benchmark �ap,o � Dosing Aeration Bidg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 43,,Z�.' TANK TO P/L WELL BLDG vE"TTo ROAD Dt Inlet AIR INTAKE Septic �y� .�.,Z,S� �` �� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header!Man. 4�.,2s� Holding Dist. Pipe PUMP 1�IPHON INFORMATION Infiltrative Surface I�-2S� Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INF R TION DIMENSIONS W ,3 � yY yy� yy� � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv o Aggregate �I INFORMATION P/L Bldg Well Waters o G � Chamber Model Number: ❑ EZFIow CELL TO -}(o a. ' ❑ Mound o Other QY� ------ -—-�1— �- DISTRIBUTION SYSTEM X Pressure Systems Only — -- _— - — Header I Manifoltl Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia l Length Dia Spac Spacing 0 Yes ❑ No -- — --- SOIL COVER - _ __ _ ______ -- --- ( Depth Over Depth Over li Depth of — _ l Seeded/Sodded I Mulched � Cell Center Cell Edges � Topsoil_ � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) � �� =��(l�1 ��s(� 3 �r �� l�,�,�y,bH> � �..� ��. �,'�,,,? S o�,� � � s��e 1�� 1`�� ' v°.� �3- � �- �� ? ---� Plan revision required?�Yes ❑ No p Q� a , 6�� a. �r _— -- � �� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3I01) A��ITIDNAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA:_ ��_ a�3__. �� .� � �� , �� t--� . � ; t ,�,�¢� : : �?e,1Y � --- - - ; -- -_- �ar � — -- —� , \t�" • � .__.._ t . ,`` . �i �� I f �I � ' � � �� . � o � �� Cq) • L— — �• 61\ �� ''� .��,�� C� � �� ? � Q�� r .� � c �� -�- ��. �� . �a �.---