HomeMy WebLinkAbout026-939-17-5219-SAN-2022-278 - ' [ndustry Services Division County `�/
, � 4822 Madison Yards Way Sawyer �
= Madison,WI 53705 Sanitary Permit Number(to be filled in b} �
�: P.O.Box 7302 q
Madison,WI 53707 �p 3 I �-� ( �
State Transaction Number �
Sanitary Permit Application '
� �In accordancc with SPS 383.21(2),Wis.Adm.Codc,submission of this form to thc appropriatc govcrnmcntal unit J
is required prior to obtaining a sanitary permiL Note:Application forms for state-owned POWTS are submi[ted to Project Address(if different than mailing
the Department of SafeTy and Professiona(Services.Personal information you provide may be used for secondary �q
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. ._.
I.Application Information-Please Print All Informarion
Property Owner's Name Parcel#
Robert Berg 026939175219
Property Owner's Mailing Address Property Location
16206W State Hwy 70 Govt.Lot 2
City,State 7_ip Code Phone Number
Stone Lake WI 54876 �%. ��, Scction 17
II.Type of Building(check all that apply) Lot# T 39 N R 9 E or W
�1 or 2 Family Dwelling-Number ofBedrooms 2 3 Subdivision Name
Block#
�ublic/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number illagc of
31 /72 #7680 oTOWf°f Sand Lake
IIL Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C i
a Iicab►e.
A' ✓ ew S stem �7,,e lacement S stem ther Modification to Existi�>>S stem ex lain Additional Pretreatment Unit ex laui)
� Y� � µ� P Y• 6 Y• ( P ) ❑ ( P
u
B' �Holding Tank ❑In-Ground �4t-Grade �Mound Individual Site Design Other Type(explain)
(conventional)
C. �Renewal E3efore �Revision hange of Plumber �ransfer to New Owner �St Previous Permit Number and Date Issued
Expiration '�
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Uesign Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
300 .7 429 446 92-95
Capaciry in fotal #of Manufacturer
U
Tank Information Gallons Gallons Units � V U v N �
New Tanks Esisting Tanks � o � 2 � � ctl �
c. U in �, r7� i.i, C7 0.�
Scptic or Holding Tank 750 ]�j0 � WI@S@f ✓
Dosino Chamber � �
V.Responsibility Statement- 1,the undersigned,assume r nsib' y f installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plmnber's Sib re MP/MPRS Number Business Phone Nmnber
Dan Burch 253808 715.416.1642
Plumber's Address(Street,City,State,Zip Code)
N5921 County Hwy K Spooner WI 54801
VI.Coun /Department Use Only
�A o d ❑Disapproved Pertnit Eee Date Issued Issuing Agent Signature
$ (� �� � � � .�j,^�,, - -
❑Owner Given Reason for Denial (�D•� � 1 a�`/�� �C�"�-C•�-e-f/"""'-�r.., - - � '"'�
Conditions of Approval/Reasons for Disapproval ["'�``'��
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Attach to complete plans fnr the s tem and submit to the Cnunty only on paper nM leas than 8 V2 x 11 inches io ske
y 0?�41a
SBD-6398(R.02/22) NO R�FUNDS AFTER
ISSUE OF PERMi7
PAGE 1 OF 4
In-Ground Gravity Plan
Index � Cover Sheet
Component Manual Desian Refe►ences
i/6rts�s� �. ) �v�l-zoa�
Pg 1 of 4 Index&Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispe�sal Area Cross-Section&Plan View
Pg 4 of 4 Management Pfan
Attachments: ��
POWTS A lication for Review
Soit Evaluation Re rt&Site Ma
Project Name 1 Description
Owner Name(s):�1%�T ��lr2�N�, Phone:
�^Jo�C-L.�;{
Owner Address:�� �'� 6 L� �j}!�G�''''' ?� ,,•�=SY�3)b ZIp:
Project Address: S�'""'e-
Govt Lot:� 1/4 of 1/4,Section�_,T 3 1 N-R�,E�or W�
Townshlp: ���..1 � l i� County: S`w���
Project Parcel ID#: � �h Y 3�( �7 S� (�i
Designer Information
Deslgner Name: Dan Burch Phone: �15 _416 _1642
Designer Address: N5921 Cty Hwy K Spooner WI Z�P; 54801
E-maiY B�rchplumbinginc@gmaii.com This space resemed for approval stamp.
License Number. 253808
Remarks:
Signature• Date: �� ^� �
Qipin si9�elure ieQuirod on each aubmltted coPY•
CHECK BOX AS APPLICABLE. CM W K BOX AS APPLIC/OIE.
✓� SUIL EVALUATION o s�aie: t�30' as so � SYSTEM PAGE 2 OF
S1TE MAP PLOT PLAN
PROJECT NAME: �5, DESIGN FLOW' .300 cPo
Robert Berg Attach design flow calcula6ons for commercial plans.
PROJECTADDRESS: �F)ZOF)WS�BYeHWy �O � PipeMaterial/ASTMStandard(Tables384.303&384.30.5)
sanitarysewer SCh 40 PVC �
BM SymboC � BM Elevatlon: ��� FT Force Main: /
BM ceu��;a�, bottom trim of buiiding
Slo e GradieM % Inaicatenmthby IMPOR7ANT:
P ( 1�� Weli Symtoi(if apprcamep. 0 araw�oq a�aRw, Show ground elevation contours at suitable intervals.
Of Tested Arta on the ap0�oprlte Ilire.
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Septic Tank(s) Manufact�rer:
IN-GROUND GRAVITY DISPERSAL AREA wieser
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:
Polvlok
�
Effluent Filter Model#: 525
min. �2"
(�YPical)
SOIL COVER
�2~
min. Vench
depth �
�n�P��n �� � TYPICAL TRENCH
�- -- �- • — : . -� �� �� ��°�.a� � �. CROSS SECTION VIEW
�— aa . .a. . . ' (NO SCale)
(�YPical) �,'a .
w . e ,. . ..
. ° Provide minimum 3 ft
System Elevation - 94 ft separation between trenches.
(typical)
Quick4 Standard-W
w/ End Cap Observation Pipe TYPICAL TRENCH
t ical (Show location of inlet / outlet pipe connection on plan view.) (typical)
� Yp � Install per manufacturer's PLAN VIEW
— — — — — — — — — — — — — —
'� `� °"S� (No Scale)
� � �i� - �i� - ��- -
��a'�'��4�.��tt� — — — — — � ��' �t , � � �A = 3 A ft
�* ,��i�� 1k'�.�.{4`a e s — — — — — — — _ _ — — _ _ — — —��'+k #r . _ � �tYPICaI) �
— — — — — — — �� �� D
VJ
B = 90 ft -I m
(typical) Quick4 Standard-W Chamber W
�tYPical) O
INSTALL PER TRENCH: �rntd by �nr�tratorsyster�, �nc.) �
22 Install pursuant to manufacturer's instructions. �
Quick4 Std-W @ 20 f� EISA/chamber = 440 ft2
+ � Pairs of end caps @ 6 ftZ EISA/pair = 6 ftZ
= Proposed EISA per trench = 446 ftZ Required Infiltration Area = 429 ftZ Distribution Method:
x � trenches = Proposed Total EISA = 446 �Z
WLP750—MR
TANK SPECIFICATIONS � o
� �
DIMENSIONS: � ~
w �n
� o
WALL: 2 1/2" a a
BOTTOM: 3"
4" CAST-A-SEAL 4" CAST-A-SEAL COVER: 5" w
MANHOLE: 24" I.D. PRECAST CONCRETE RISER Q
� ---� HEIGHT: 54" �
�:'�� �`��
��� ��� OUTSIDE DIAMETER: 7'-0" �
��� � ��� BELOW INLET: 42° �
ii �`L�Q� �� LIQUID LEVEL: 37"
�� i� �� � i'—`���� WEIGHT: 6,150 LBS. o
� � � i
� � � � INLET AND OUTLET: ,i � o E
� � _�� �. �� � 4" CAST-A-SEAL BOOT OR EQUAL GASKET - 3 � o
�� - - -�i � r � �
�� FILTER OR �i� � m o a
��� BAFFLE �� INLET AND OUTLET BAFFLE AND FILTER: w Z � 3
��� „� WISCONSIN, SEE DETAIL #10 Q Q � w
`�� ,;�' (OTHER STATES SEE CHART) N a o �
LIQUID CAPACITY: 2Q.28 GAl/IN �� o
�
H �
W �
TOP VIEW HOLDING TANK: �
OUTLET HOLE PLUGGED �
ACTUAL CAPACITY: 790 GALLONS � � �
� � �
LOADING DESIGN: 8'-0" UNSATURATED SOIL � Q �
�
o TANK CAN BE USED AS: � � N
W SEPTIC / HO�DING / PUMP OR SIPHON o j�
�
a� COVER: MIX DESIGN #8 (NO FIBER) � _ �
+� TANK: MIX DESIGN #10 (STRUCTURAL FIBER) W �
� ____ CUSTOMIZED TANKS: °
_ ____ ____ . �_ FOR CUSTOM TANKS CONTACT WIESER CONCRETE � �
INLET - OUTLET
it � I — —I I Q
�Q — — I ��
�n - c� I ^ cD I � � _ J
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d a�Y ,� M � ��. � �' �
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21,. �---�_ .�' � Q
2
----s-.-_-✓ � �
REVIEWED BY a c�
PUMP PAD
� REVIEW DATE � a�.
w
�
DRAWINGS SUBMITTED
SIDE VIEW FOR APPROVAL
APPROVED BY: SHEET N0.
APPROVAL DATE: � �
OF
PRODUCTS NEEDED BY: / �
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIRfMENTS
PAGE40F4
In-ground Gravity Management Plan
{MP�IRTANT:
The owner of this in-ground gravity system shali be responsibie for its perpetual operation and maintenance pursuant to
requiremerits of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this system shail
be considered a human health hazard if not maintained in accordance with this approved managemant pian.
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 Oaeratins� Limlts:
Design Flow= � � '� gpd; BODs<_220 mgL''; TSS 5150 mgL''; FOG S 30 mgL"'
Insuectlo_n Checklis_# INSPECT EVERY 3 YEARS
o type of uss
o age of system
o nuisance factors(i.e. odors, user complaints, etc.)
o mechanical maifunction (i.e., pumps,vaives, switches,floats, etc.}
o material fatigue(i.e., leaks, breaks, corrosion, etc.)
a solids volume in anaerobic trestrnerit tank(s)and any distribution appurtenance(s)(i.e.,distribution/dr�p boxes)
o n�lect or improper use(l.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing ir�egularities-if applicabfe(i.e.,pump re-cycling, float switch settings, efc.)
o electrical components-if applicable(i.e.,wiring, connections, switches, controls, timers, alarms, etc.)
a distribution latera!or lateral or'rfice plugging (measure lateral distal p�essure—compare to deslgn specificafion}
o surface discharge af effluerrt or sewage back-up into structure served
AAaintena�ce Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tank(s)shall be p�nped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats.when the volume of soltds tn the tank(s)exceeds one-thlyd(1/3)the tiquld volume of the tank(s)or
as requir�by local ordinance. Disposal of conterrts shaN be pursuant to NR 113,Wisc.Admin. Code.
o Efflusnt fllter(s)shall be inspected every 3 years and shall be deaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A serviang period will always be greater than 12
months.
System maintenance reports shall be submltted to the proper local govemment unit In accordance wlth
SPS 383.55 Wisc.Admin. Code. Report any component failure or malfunctlon to:
Name of individual or company: Dat1 BUI'CI1 pho�: 715.416.��2
Locai goverr,mer,t���� Sawyer County Zoning Phone: 715.634.8288
Local govemme�unit address: 10610 Main St. #49 Z�p; 54843
Any defective part of this system shall be repaired, reptaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code.Repaic or replacement of failed or maffunctioning components shall comply with SPS 383,�sc.Admin.Code.
No produet 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
!n the event that any failed treatment component of this POWTS cannot be repaifed, it shatl be replaced pursuant to
a pian submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-camplying dispersal oomponerit 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.
Oi7icc of
,
Sawyer County Zoning and �e ' - �
� � 1c��
Conservation Administration ` " !
</%' '`C�°��? � '
IOG10 Main Strcct, Suitc 49 �+' ���J �/� � �
Hayward, Wl 54843 1 J �� ����
�r�i: c��s� ��:�a-x2xx '�� Q `'� �
1'ax: (715) G38-3277 y,�tn,, � � �;,f��3 �
URL: htt�r.iisatv��r_rryunly��uv.��r� ��nl/ '` YF
I�,mail: z�inin��.srrr�r!smt��rrutin�}y�n'.��r_; NGqOM��(�N�.
l�oll Prcc: Courthousc/Cicncral Inlimnalion Srqq�Q j
t-R77-699-4110 N I
Sawyer County Zoning and Sanitation "As - Built" Form
, �. ,..
Property Owner's Name —�-_9_�C�-�T-_--��V------ ,
Fire Number and Road Name �� � `'`� 171�fL�� �n
-��- - ---� -- -
Plumber's Name � _V n" � H
----
� --��^�---� _- -----__._..--- �
Date of Installation �� ^ � L' `'�" ��
County Sanitary Pennit Number __�_� — � 7�
r L
12 Digit Parcel Nwnber __����_� ��_�>`�=��
� �
Description and Elevation of f3enchmark ___,����1�.__._��. _____.1�_��'U
Tank Manufacturerand Capacity ____�-^�_��_j�y--�.-___--_7S_�-_---
;
Setb�ck - '1'ank to Nearest Lot Line __�? _
Setback - '1'ank to Nearest Wcll _ /J .�___�"'�P____� ____._
r
Setback - "1'ank to f3uilding __ - __�_�"�._._-__- ---- --
Ccll Width -----.-`" -------- ------ —
Cell Length ___- � `�
Numbcr of Cells ___.____�-----
Setback - Ce(1 to Nearest Lot Line _____ �__`�___—_____�-.-__---------
Setback - Cell to Nearest Well �' `-' � < < � ------
(
Setback - Cell to Buildinb ---��---------.------.___
Setback - Cell to Navigable Water � � .- .------- -
------ -- /--- - -- �_-
I ' f ,/�-�� I �1�'r o /
Make and Model of Dispersal Unit ____ ._ _�u+�i-7--- ----
,� ����_�__ � .� S
Make and Model of Filter _ � � �' �
Make and Modcl of Pump ____�_.---����------------
CHCCK BOk AS A�PLICf�BL[. CHECK BOX AS APPLICADLE.
✓Q SOIL EVAL�JATION Scale:1^=so� Q SYSTEM PAGE 2 OF
SITE MAP ° 3n as so
PLOT PLAN
PROJECTNAME: oEsicNr�ow; 300 �vu
Robert Berg 'S�
Atlach design flow calculations for commercial plans.
PROJECiADDHESS: _ �6ZOBW S�8f2 HWy�O Plpe Material/ASTM Slandard(Tablos 384.30�8 38A30-5)
RMSymbol:�} BMElavallon'. �OO FT N sa�i�rysPwa��Sch 40 PVC �
Forco Mnin'. /
enn o�:�nr�b�: bottom trim of buildinp
Siopo Graaiont�%yr i��icme nn�in W IMPORTANT:
otTesleAAroe: �NollSymbolQlepplicableJ: 0 ac�wmpemm�« ShowgroundelevalionconloursalsuitablelNervals.
on Ih�npProprlle Ynn.
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