HomeMy WebLinkAbout010-941-23-3317-SAN-2022-226 ���h11t1 � ��,
,, ';, ,%1 S b Vt; I� ��a �� Department of Safety c�°°�y S, �U �
nl {� & Professional Services, y
� ~'�'��: � l�' I a � �D ` Industry Services Division Sartitary Pcrmit Num (to be filled in by `
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Sanitary Permit Application State Tiansaction Alumber �
In accordance with SPS 383.21{2),Wis.Adm Code,submission ofthis form to the appropriate govemmental unit r— �
is required prior to obtaining a satntary permit.Note:Application forms for sqtc-owned POWTS are submitted to Project Address(if different than mailine �
the Department of Safety and Protessional Services.Peesonal information you provide may be used for secondary �
pwposes in accordance�vith the Privacy Law,s.I S_04(1 xmj,Stats. e���
I.Apptication Information-Please Print All Information 7
Property(hvner's Name Parce(# .�7J--7��L O,_�-��_��-
_ ,e `� ��
d 3-000-
Property wner's Mai ing Address Property Location O l0�q�((.-� � 33�7
� + Govt.Lat
City,State Zip Code Phone Numbcr �+
� �U� ��� `��J�D7J�`O orl J� y..SIA� !/<, Section��
IL Type of Suitding{check all that apply) Lot# T �� N R � E o
II l or 2 Famiiy�vclling-Numtxr of Bedrooms ,✓ Subdivision hame
Block# —'
❑Public�ommercial-Describe Use
�City of
47 State Owned-i}escribe Use CSM Number ❑Viliage of
�Town of b-�Ot./�i �l�i�
III.Type of POWTS Permit:(Check either"Ne�"or`Replacement"and other appiicable on line A. Check one box on line B.Complete line C if
a licable.)
A.
❑ New System �Replacement System ❑Other�loditication to Existing System(expiuin) ❑Additional Pretreatment Unit(eaplain)
B.
❑Holding"I'ank �Io-Grouncl ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
{conventional)
C- ❑Renewal Before ❑ Revision ❑Cfian of Ptumbrr List Pre�ions Pemtit�lumber and Daie[ssucd
� � ❑Transfer to New O�vner
Elcpiration Q,-Q 6� �'�/�
03
IV.DispersaUTreatment Area and Tank Information:
Design Flow{�pci} Design SoiE Anplication Rat�(epii`s� Dispei:ral Ana Reyuired(;tl Dispers�l Area Pro�±c�sed(s� System Ele�ation
� 7 �o ,j S�
Capacity in Total #of Manufacturer ��
Tank lnfannation Gatlons Gallo�s Uniu Q � � v
U
New Tanks F�cisting Tanks J � � L U � c '�
O.. :J v] �n. V1 =c. v G..
Se�ic or Holdine Ta� �Q 6 O /� `O / � �/ � �
! p
I)oi;�Chamber
V.Responsibility Statement-I,the endersigned,sssume responsibilih�for installation of t6e t'O�V7'S s�own on the attached plans.
Plumber's Name{pn��} P{umber's '� turc 11-1P(MPRS Number Business Phone Nwnber
� Cc'�, _ �g - ��--1b7
Plumber's Address(Street,City,Sta[e,Zip Code)
� C�-��C. � � �
VI.C u ty/Department Use Onl,y
}cX Ap � ve 0 Di,appro�ed Pemrit Fee Date lssurd lssuing Agent Signature
�✓ � `�a� � ' �� a�aa � �
Q awner Given Reason Yor IJeteial '
Conditians of Approval/Reasons for Disapproval
.,
�+ � �afaa � �;��V' ,�'-�
�-�� IN� . _ ` - ��
� �����_�__ ,
I c� R q AUG 3 1 2022 �.��
CS� �� �-1SI ) � N� ....1,���� � 3�5
SAVVYF� CQt;:�.l i Y
�t/t ZONING ADMINI;il"RATIOfV
' Attach tn co�npkte plaas fnr the s}stem and submit to the Counh only on paper not Icss thnn 8 ti2 x ll inches in sizc
SBD-6398(R.03!22) �3l'' R�FiJNDS AFTER i� 9�
+SSU�OF PEkMIT S
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):�'(�d.d..F,�-�'���e�S�.(..��rt�1 Phone:'l�S-�-��
Owner Address: ��5�!J�j l� I�A,i�Y�;�KQcC�cJv�`C'Vuc,� I,-�c�GCQ��ip: '�j�,��
Project Address:
Govt. Lot: Si� 1/4 of s�.l� 1/4, Section a� , T �� N-R o� E Q or W�
Township: ����'� County:
Project Parcel ID #: ��-o!�- �--�t��-�l--�-3 3 03 -- �oc��o o t� b
Designer Information
Designer Name: 1��_�� ��D� Phone: CS -SS�f-l�
Designer Address: � � Zip: �� �
� o
E-mai l: �1'i'c���"`�" ;t:
,
License Number: ��?j�(
CI
Remarks:
Signature: Date: �3 L c�-a
ri al signature required on each submitted copy.
Plot Plan �� �y
-� ��
PROPERTY OWNER: S+%�D�k I,. �L-s5r1 KD Ff �c,Dt� E'� 1"_= 40 Ft.
C�q I244�Iq$8 TN�K E (except where rated)
LegalDescriptbn: YrL cr- Sw 4 CF TNE `�`.`��l _ ' Zi�T41N. /ZGi3W � =badchoepit
-rcwti' CF �I,i�w.�Ki� sfi�ysrz CctiNTy. w�sc�NS�N. 1.7z h�rt&s
5�-oio-Z-vl- D�-z�-3 �3- Gor�-nCoi�o� IDS(c3,�J 1��A,+�6W�-^,V "��L
North
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6
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Site location: .���'��
�.�
{ �
i �/t,
, z ,l
Septic Tenk(s)MarwfacWrec
IN-GROUND GRAVITY DISPERSAL AREA XYI/./ilfve���r
Uniform Elevation Trenches with Quick4 Standard-W Chambers Septic Tank(s)Vdume(s):
3-ft Trench (down-sizing credit) �, j�Q�, �, ae,
Eifluent Flller Menufachiror
ORENCO L-1,'n ._ �'��/��P .
I
EMuent Fllter MoEel p: /'�CJ� ,.22
min tT
SOIL COVER ������
iy
min.trench
aP� TYPICAL TRENCH
(Ndcap .
' a �. CROSS SECTION VIEW
` �no�� • (No Scale)
, • � ' Provlde minimum 3 ft
System Elevation = 95.00 ft separatbn behveen trenches.
(typical)
Oulck4 Standard-W
w/Ena Cap (Show location o�inlet/outlet pfpe connecdon on plan vlew.) ODselryeDll�;Ipe TyPICAL TRENCH
(rypicaq InstaNpermanNatlureY6 pLAN VIEW
��"`�"�"' (No Scale)
- - - - - -
�� —� — —..... �'f— �f — — — —..—..�..—...—.—. ...—.�.� T
r • er-r ...... . �r - - - - - - - �,�- - �� j.�l 1A= 3.Ofl
.u.• .•••u�r�r. — — — — _ _ u ul•.•�•• �u��J 1. Ihdcaq � �
— D
B = 66 "'
ft �� m �n
(ryp���) 450 GPD DIVIDED BY OJ LR= Quick4 Standard-W Chamber W �
INSTALL PER TRENCH: 642.86 F'P. 2 lliVIUED BY 20 �ryP�Ce�� O \
(mfd by Infllimla Sri�ams.inc.)
E[SA/UNIT =32.ISOA32 In�lalpwwanibmanuhclurorslnetruabna. � -y
16 Quick4 Std-W @ 20 ft EISA/chamber= 320 ftUNITS X 4 FT= 128 FT. z
+ �� Pairs of end caps�6 ft EISA/pair= 6 ft��VIDF.D BY 2 = 64 FT. m
TRENCHES 3' X 66'
= Proposed EISA per trench= -�Z�' ft Required Inflltratlon Area= 642.86 g= Distribution Method:
x �j_ trenches = Proposed Total EISA= Fsz ft° branched manifold
RESET
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 inspedion and maintenance activities shall be perfortned by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Operatinq 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, 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 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 certfied 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(s1 shall be inspected every 3 years and shall be deaned 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 govemment unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: ��i�'� "�'I,�f'� Phone:��S�J�S'-�C���
Local govemment unit:�u �l �- Phone:���-(o��C�a�B
Local govemment unit address: ��11n/l1 IU n.'1n �-(- �t��d�r ,�i�ZIP: � ��5�.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 wmponent 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.
Jv
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, ,a�� �. ori��e�r , . �'�
��� � Sawyer County Zoning Adnlinistration ����'
10610 Main Strcct Suite 49
��.��� Hayward, �'Visconsin 54843
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�ER coG�l �7i;�c�3a-s�Rs ,, ;,�' � � c��
I FAX(715163h-�277 /ri � �� ��0�� �1� r�
i� ZI ! 'J r. 17f1 9is, ��f,`,,���
�Q , �.1 I www.sawycr_cnuntv�ov.org � � � -���} 4,�� � +..�
�(� � �C� E-maiL zonincsecia tia��vercountygov.org /� �1���i 1';
�,� \ < � i Toll Free Courthousc/Gencral Information 1-(377-699-41IU �`��tJ�j 0 v 4+f�
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Zp�'�"y q^ �
�I�SCON��� �_
����.� NII`�G 13�;�'j�y�_
AIN��T���
SAWYER COUNTY SANITATiON DEPARTMENT
TEMPORARY EMERGENCY TA1�K INSTALLATION APPROVAL
PROPERTY OWNERS NAME: �o�� C �'�q� b- 5�,�� �eSSar-�
TOWN OF: �-�a�o.�
ADDRESS: � (US���V Na✓`1-Z�,{�So� `��- '.
i, � � n ✓1 � , a Wisconsin
Licensed P ui��ber, authorized by the owner, do hereby acknowlcdge that I am receiving
temporary approval to install a septic tank/holding tank without a soil and site evaluation,
or existing system evaluation, and private se�vage system plan review due to inclement
weather and/or health and/or safety emergency.
Further, I acknowledge that a soil and site e�aluation, or existing system evaluation, and
private sewage system plan review will be c��nducted by the deadline stipulated by the
permit issuing agent, or as soon as weather co��ditions or circumstances per7nit. 1f the
private sewage systcm is found to be failin�as de�ned in s. DSPS 381.O1 (92), Wisc.
Adm. Code, coi7�ectivc measures will be takcn as such that the private sewage system
complies with all applicable requirements of�chapter DSPS. 3R3, Wis. Adm. Code,
within 90 days of this agreement.
I furtt�er acknowledgc that failure to comply by obtaining all necessaiy permits after the
deadline date may result in tl�e issuing of a citation, under Section 11.3 [2) Saizita�y
Permits], of the Sawyer County Citation Ordinance.
DEADLINE R THIS AGREEMENT SHALL BE: 1���
Signed: - '
Date:
� g�3 2
Accepted by: y � ��--�
Date of temporary emergency approval: ��3� ��
Rev. 03/26/13
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