HomeMy WebLinkAbout004-739-07-2202-SAN-2022-229 C/�
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����=��'-".;;, [ndustr}'Services Di��ision County
%�' �` 4822 Madison Yards Way SAWYER �
� � � " Madison.WI�370�
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�=1 �, t� j= Sanitary Permit Numbcr(to be filled in by( �
' � _ ' P.O.f3ox 7302 p� �
``;'�:;r;� =;�r%/ Madison, WI 53707 � �� � ( 0
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State Transaction Number �
Sanitary Permit Application �
In accordance with SPS 38321(2),Wis Adm Code,submission ofthis form to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if diffcrent than mailing ac_ ___,
the Department of Safety and Professional Serviccs Personal infonnation you provide may be used for secondary ����p�p� r-+����� ��� ��
purposes in accordance�cith the Privacy La���_s. 15-0-1(l)(m)_Stats (J V V l.�
L Application Information-Please Print All Information
Property Owner's Name Parcel#
BRIAN & JENNIFER REMICK 004-739-07-2202
Property Owner's Mailin�Address Property Location
1440 HIGHVIEW AVE �;��� � ��,��w
City,State Zip Code Phonc Number LL,_�--.��(n/ �� � Y
EAGAN, MN 54828 _�� o�. se�t�on ��
TI.Type of Building(check all that apply) Lot# T 39 N R �� E W
� I or2 Pamily Dwclling—NumhcrofBedrooms 2
�— Subdivision Name
Block#
�Public/Commercial-Describe Use � ��
�City of
--
❑State Owned-Describe Use CSM Number �Village of
� �To��n of COUDERAY
Ill.Type of POWTS Permit:(Check cither"New"or"ReplacemenY'and other applic:►ble on Iine A. Check one box on line[3.Complete line C if
a>>licable.)
`� New S st�m Re lacement S stem Othcr Modification to Existing S stem ex lain Addilional Pretreatment Unit ex lain
�✓ Y , � P Y � Y ( P ) ❑ ( P )
B' �Iiolding Tank �In-Ground �At-Grade �Mound �individual Site Design Other Type(explain)
(conventional)
�• ❑Renewal Before �Revision �Change of Plumber �l�ransfer to New Owner�'�st Prcvious Permit Numher and Date Issued
F.xpiration ��,.�� ����� �
1V.Dispersal/Treatment Area and Tank Information:
Design Flo�c(gpd) Desien Soil Application Rate(gpdis� Dispersal Area Required(sf) Dispersal Area Proposcd(sfl S}�stem Ele��ation
300 0.7 429 452 9S,o �
Capaciry in 7btal #of Manufacturer
Tank Information Gallons Gallons Units � � v �„ �
New Tanks Existing Tanks y o a� � � � ro �
°y' � —
� U v: s :n ., J —.
SepticorHoldingTank 750 750 1 WIESERCONCRETE ✓ �
Dosin�Chain6cr � � �
V.ResPonsibility Statement- 1,the undersigned,assume sponsibility for i st tion of the POWTS shown on the attachcd plans.
Plumber's Name(Print) Plumber ignature MP/MPRS humber Busincss Phune Vumber
Travis Butterfield - 652879 715-634-8176
Plumber's Address(Street,City,State,7ip Code)
14346W St. Rd. 77, Hayward, WI 54843
VL C u /De�artment Use Only
�n� rb�ed ❑Disapproved $crmit Fee Date[ssued Iss�e Agent Signature r
�� 1 00.'° q � ,
� � .c�-�-4-�-y.....�,
❑OwnerGiven Reason l�x Denial � � �� 1�"""�"
Conditions of Approval/Reasons for Disappro�al , , a I � I2 ti ��� ��.���`, r'� '�'� �
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ZON{NG ADMiNiSTRATIOtd
Attach[o complete plans for the system and submi[to the County only on paper not Iess[han R 1/2 x 11 inches in size
s���-639s�R.oziaa� Np REFUNDS AFTER
ISSUE OF P��tT �0 lD��"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
Remick
owner Name(s): BRIAN & JENNIFER REMICK Phone: - -
OwnerAddress: 1440 HIGHVIEW AVE, EAGAN, MN Zip; 55121
Project ,4ddress: 12068W COUNTY HWY CC, COUDERAY, WI 54828
Govt. Lot: 1/4 of 1/4, Section 07 , T 39 N-R O7 E ❑or W ❑✓
Township: COUDERAY County: SAWYER
Project Parce� �� #: 004-739-07-2202
Designer Information
�esigner Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176
�esigner �4ddress: 14346W ST. RD 77, HAYWARD, WI zip: 54843
E-mai�: OFFICE@BUTTERFIELDDRILLING.COM �1���:;;E���� ��«w�r����t �z 3���,1.�,��t� 5��:,�1_�.
�icense Number: 652879
Remarks:
Signature: Date:
g- �( -�
Original signature required on each submitted copy.
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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) 750
gal gal gal gal
Effluent Filter Manufacturer:
BEST
�
Erfi�e�c F�icer Modei#: GF10-8
min.12"
SOIL COVER (typical}
12"
min.trench
depth •
�riP��a�> ��. • � TYPICAL TRENCH
� • . -� �� � ��°�.a��•. CROSS SECTION VIEW
F 34�� ��� �a� �� � (No Scale)
��YPical) ';'a . .
., " ..
. • •' Provide minimum 3 ft
System Elevation = 9S•� ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap (Show location of inlet/outlet pipe connection on plan view.) obse(ryaPtioal)Pipe TYPICAL TRENCH
(typical) Install per manufacturer's PLAN VIEW
instructions.
(No Scale)
� - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - - -�
`� • I �.� ��,' s ' ,' . I �A= 3.0 ft
(typical) �
�- - - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - � D
�-- B = ft - � �
rn
(typical) Quick4 Standard-W Chamber W
(tYpical) O
INSTALL PER TRENCH: (mfd by��ti�t�ato�sy5tems,���.) �
Install pursuant to manufacturers instructions.
11 Quick4 Std-W @ 20 fi� EISA/chamber= 220 ft` 'p
+ � Pairs of end caps @ 6 ft�EISA/pair= 6 ftz
= Proposed EISA per trench = 226 ftz Required Infiltration Area = 429 ft` Distribution Method:
x 2 trenches = Proposed Total EISA = 452 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= 300 gpd; BODS<_220 mgL''; TSS<_150 mgL-'; FOG<_30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
, age of system
„ nuisance factors(i.e.odors,user complaints,etc.)
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 irregularitles-if appllcable(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 laterai 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 ope:rator 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�13,Wisa 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: BUtt@I"fl@�C�, �C1C Phone: 715-634-H�76
Local government unit: SBWy@f COUllty ZOning Phone: 715-G34-828H
�ooa�go�er�ment�nit address: 1061 O Mal1'1 St. Suife 49, Hayward, V 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 department in
accordance with SPS 384,Wisc.Admin.Code.
Contingencv 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 solls.
Svstem Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.
OPfice of 7�l,,
Sawyer County Zoning and %� °���
;,�° �
Conservation Administration . �.�;f�j �:�r`:,s'�,��
:`�:,�?. i
10610 Main Street, Suite 49 �-•,+;, j�.�>..�
Hayward, WI 54843 �..�'��°�� ��, �\�; '
Tel:(715)634-8288 � �,�. �� �
Fax:(715)638-3277 ��^'�(�+ ��`,� ���
URL:http://sa�vvei•countyQov.org ��'����t3�
Emai1:zonin�.sec,ct sa.w��ercoiu�tygov.or� ���'��S'
Toll Free:Courthouse%General Information �0�;,
1-877-699-4110
Sawyer County Zoning and Sanitation "As - Built" Form
�
Property Owner's Name � '����^ �' ��6""'�� �1�'6�r��
Fire Number and Road Name �����'� C���w��''����`� ��
Plumber'sName �� '��tS `7��-�'`��?��`
Date of Installation �� ��`'2 ��
�� � � � °�
County Sanitaiy Permit Number _
12 Digit Parcel Number �-���� ��y � � � � �`���
Description and Elevation of Benchmark �"` ( �`� g m`t�°� ��'� _�`�`�.`�
��r t?J,� W �
Tank Manufacturer and Capacity !� 5 � ��C �c�
1
Setback-Tank to Nearest Lot Line ��a �
Setback-Tank to Nearest Well
rao-� '
� �
Setback-Tank to Buildirig _ _ _
Cell Width
y �
Cell Length _ yL�
Number of Cells � � �
Setback-Cell to Nearest Lot Line ���� f'L
i
Setback-Cell to Nearest Well �U O 'f"
Setback-Cell to Building �S
i
Setback-Cell to Navigable Water �"`�
Make and Model of Dispersal Unit ��^--�C� �� ��``S
Make and Model of Fiiter �j�-S �` �� fD --�
Make and Model of Pump
-Please complete other side -
"As-Built Plot Plan"
Elevation Data
Benchmark �l � E' Please include the followin�:
Building Sewer _.��� `_'
Tank In �'y° � Location of observation and vent pipes
Tank Out '7�� ' Feet of risers used on tank(s)
Dose Tank In — � I,ocation of benchmark and North arrow
Dose Tank Bottom — � Location of all components
Header or Manifold � `D ` � Length of pipe between components
Distribution Pipe — � Number of chamber units in each cell
System Elevation y b � Location of well, lot lines and road
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