HomeMy WebLinkAbout002-940-04-2215-SAN-2022-279 � Industry Services Division County �
i � � 4822 Madison Yards Way Sawyer �
: s Madison,WI 53705 Sanitan Permit Number(to be filled in by�
�= P.O.Box 7302 2
Madison,WI 53707 �p J� 2� 3 �
�
Sanitary Permit Application State Trensaction Number �\
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[n accordancc with SPS 383.21(2),Wis.Adm.Codc,submission of this form to thc appropriatc govcmmcntal unit J
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a� �
the Department of Safety and Professional Services.Personal infortnation you provide may be ased for secondary Sommer Ln
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats.
I.Application Information-Please Print All lnformation
Property Owner's Name Parcel k
Sawyer County Housing Authority 002940042215 u�,� #1.
Property Owner's Mailing Address Property Location
PO Box 791 Govt.Lot
City,State 7ip Code Phone Number
Hayward WI 54843 �%, �;. S��t���, 4
li.Type oi Building(check all that apply) y Loc# T40 N R 9 E or w
�l or 2 Family Dwelling-Number ofBedrooms 4 ��l �� � Subdivision Name
Block#
�ublie/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number illagc of _
�T�µm of Bass Lake _
1I1.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.)
A.
✓�Iew System �eptacement System her Modification to Existing System(explain) ❑Additional Pretreatment Unit(explaui)
B' �1-lolding Tank In-Ground �4t-C.rade �Mound Individual Site Design Other Type(explain)
onventional)
C• ❑Renewal Before �Revision hange of Plumber �ransfer to New OwnerList Previous Permit Number and Date Issued
Expiration �
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Uesign Soil Application Rate(gpd/s� Dispersal Area Required(st) Dispersal Area Proposed(s� System Elevation
600 .7 858 866 91-95
Capacity in Cotal #oF Manufacturer
Tank Information Gallons Gallons Units � V v ,�, � �
New Tanks Existing Tanks 4 o v ? y � � ;�
n. U in �, vi c�. C7 W
Scptic or Holding Tank 1250 1250 1 wieser �
Dosing Chamber � �
V.Responsibility Statement- 1,the undersigned,assume res sibili for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Sign re MPih1PIiS Number Business Phone Number
Dan Burch 253808 715.416.1642
Plumber's Address(Street,City,S[ate,Zip Code)
N5921 County Hwy K Spooner WI 54801
VI.C o /Department Use Only
�A ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
$�(!�-a° �o � tn �a� U:�-Q�.�.,�,�--
❑Owner Given Reason for Denial
Conditions of Approval�Reasons for Disapproval y
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Attach tn cnmplete plam t e system rnd aubmit to the Counh•only nn prper nnt lens thrn S Ti'�z'H Mckee•In��t�tle%i,��,�
SBD-6398(R.A2/22) NO R�FJNDS AFTER
I�SUE OF PEFMCT
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PAGE 1 OF 4
In-Ground Gravity Plan
index � Cover Shee#
Component Manua!Desian References:
1/�'r�s��s„i �. 1 a v�1- � �a -�
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan �ew
Pg 4 of 4 Management Plan
Attachments: Encl ure :
POWTS A lication for Review
Soil Evaluation Report 8� Site Ma
Project Name / Desc�iption
�r4rJ
Owner Name(s): �'^�i�� '✓5� '"'�� ��Phone:
Owner Address: �-� ���C 7 � I Zip:
Project Address: � �^�� �'�' �'J rn
Govt Lot: it4 of 1l4, Section � , T `f� N-R `� E�or W�t
Township: A7�i 5 Z l� County: ��`���`�
Project Parcet ID#: �� � � K � `l � �� I 5
Designer Information
Designer Name: Dan Burch Phone: �15 _416 _1642
Designer Address: N5921 Cty Hwy K Spooner WI �p; 54801
E-mail• BurchplumbingincQgmaii.com This space reser�•ed for approval stamp.
Licenae Number: 253808
Remarks:
Signature•
� Date: 9 02 7-�,�
signaluro reQuUed on each submttted�pY�
CHECK BOX AS MRJCABlE. CHECK BOX A6 APPUG&E.
0✓ SOIL EVALUATION o S`��� �30' 45 � 0✓ SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: �by DESIC3N ROW: BOO cvp
Sawyer County Duplex Atte�h design flrny calcul�ns{w�pmme�cial plans.
vRo.,Ecrnonr+Ess: Sommer LN w' Prpe roiaoeda�i nsTM sc�aam Raaes sea.soa a sea.�)
BM Symbol: � BM E1avaWn: �� � i Y 3enll�y 8evrer. $Ch 4�PVC, �
BM Deacrlptiwr. f1Ai�1(1 POW9f PO�B Fmoe Maln: /
SloaeOradkN %1 �^tl�.^^^^q' IMPORTANT:
WtesEeaaue:� wensymeat(rca�,ncewe�: p m�ro.nam�w Stwwgroundekva8oncrontoursateuitebleintervals.
a,w approprrin�,a
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Septic Tank(s) Manufacturer.
IN-GROUND GRAVITI( DISPERSAL AREA wieser
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume{s):
3-ft Trench (down-sizing credit) �2�o ga, ge, �, �,
Effluent Filter Manufacturer.
Polvlok
I
Effluent Filter ModellR: 525
min. 12
SOIL COVER �ry���
�r
min. trench
«��> •� � ' TYPICAL TRENCH
� •- . -� �� �� ''�.a� � •. CROSS SECTION VIEW
��ry�� .-.. �; �� '� � . . (No Scale)
� . e ,. . :.
, . ° Provide minimum 3 ft
System Elevation = 94 ft separation between trenches.
�tYPical)
Quick4 Standard-W
w/ End Cap Observatbn Plpe 1-�(p�CAL TRENCH
�ryP���� (Shaw location of inlet / outlet pipe cflnnection on plan view.) (tia��)
Install per manufacturers PLAN VIEW
Inso-ucdons.
(No Sca{e)
i-- - - - - - - - - - �jL - - - - - - - -�'� — _._. _. - - :�„- - - -�
� a .� ,�, t r; �r �-�� � •��, , ��,: � � �, .c�� _ � �A = 3.0 ft
�- - - - - - - - - - - - --��- - - - - - - - ��-- - - - - - - - -�--� (Na��) �
�
g = 175 ft —_� rn
�ryP���� Quick4 Standard-W Chamber W
INSTALL PER TRENCH: �ty�'�� O
(mfd by Infiltrator Systems, Inc.) -n
43 InstaN pursuant to manufacturers instructions.
Quick4 Std-W @ 20 ftZ EISA/chamber = 860 ftZ �
+ � Pairs of end caps @ 6 ft� EISA/pair = 6 fta
= Proposed EISA per trench = 86=_, ft� Required Infiltration Area = 85_ ftZ Distribution Method:
x � trenches = Proposed Total EISA = $6= ft2
= �.:;:;
,
W1250—M R -
TANK SPECIFICATIONS � o
o a
8'-8" a �
DIMENSIONS: � o
WALL: 2 7/16" a a
4" CAST-A-SEAL 4" CAST-A-SEAL BOTTOM: 3"
COVER: 5"
_____ MANHOLE: 24" I.D. PRECAST CONCRETE RISER Q
�'�� ��\\ HEIGHT: 64 1/2" o
�i% ��� LEN GTH: 8'-8" >
ii �� WIDTH: 7'-2" �
ii _ `L�` �� BELOW INLET: 53"
I � `� ���lQ' r�'—`�� 1 LIQUID LEVEL: 47" o
`�' i � WEIGHT: 7,220 LBS. �
i � II v �
� �\� �--'� �� �%��� INLET AND OUTLET: � 3 0 0
�� // 4" CAST-A-SEAL BOOT OR EQUAL GASKET � m o N
�� FILTER OR // o .-
`�\\ BAFFLE ��i� INLET AND OUTLET BAFFLE AND FILTER: Q Q � w
`:�_ ,;f' WISCONSIN, SEE DETAII #10 � o o �
\ - ----�� (OTHER STATES SEE CHART) �, o
�
�
UQUID CAPACITY: 26.81 GAL/IN W n
TOP VIEW � �
HOLDING TANK:
OUTLET HOLE PLUGGED � � �
ACTUAL CAPACITY: 1,340 GALLONS � � �
Z
� o I
o LOADING DESIGN: 8�-0" UNSATURATED SOII Q �
� � N
Q� TANK CAN BE USED AS: � o�
� SEPTIC / HOLDiNG / PUMP OR SIPHON W 3 0
� COVER: MIX DESIGN #S (NO FIBER) � � �
____ � ---- _1 TANK: MIX DESIGN #10 (STRUCTURAL FIBER) � �
L
INLET - OUTLET CUSTOMIZED TANKS: � 3
� i FOR CUSTOM TANKS CONTACT WIESER CONCRETE
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REVIEWED BY c`nv c�
;� PUMP PAD REVIEW DATE 3 a
w
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DRAWINGS SUBMITTED
SIDE VIEW FOR APPROVAL
APPROVED BY: SHEET N0.
APPROVAL DATE: � �
OF
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: / �
PAGE 4 OF 4
In-ground Gravity Management Pian
IMPORTANT:
The owner of this in-ground gravity system shall be responslble for its perpetual operation and maintenance pursuant to
requirements of SPS 382384,Wisc.Admin.Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this system shall
be considered a human health hazard'rf not maintained in accordance with this approved management plan.
Furthertnore,all inspection and maintenance activities shali be performed by a reglatered POWTS Malntalner in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Mauimum Dispersal Area Ooeratlnn Limlts:
Design Flow= �o gpd; BODs 5 220 mgL''; TSS 5150 mgL'�; FOG 5 30 mgL''
Insoectlon Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e.odors,user complaiMs,etc.)
o mecha�ical maifunctlon(i.e.,pumps,vaives,switches,floats,etc.)
o material fatigue(i.e.,leaks,breaks,corrosion,etc.)
o solids vdume in anaerobic treatment tank(s)and any distribuUon appurtenance(s)(i.e.,distribution/drop boxes)
o neglect or improper use(l.e.,exceedi�g design capacities,prohibited acdvities,etc.)
o exte�rt of ponding in distribution c�l prior to dosing
o dosing irregularities-if applipbie(i.e.,pump re-cycling,float switch settings,etc.)
o electrical components-if applicable(i.e.,wiring,connections,switches,conVols,timers,alarms,efc.)
o distribution lateral or lateral orifice plugging (measure lateral distai pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into strudure served
Maintenanee Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Seotic and dose tank(sl shall be purnped by a certified septage servicing operator licensed under s.281.48 W is.
Stats.when the volume of sotids in the tank(s)exceeds one-third(1/3)the Iiquld volume of the tank(s)w
as required by local ordinance. Disposal of contents shali be pursuant to NR 113,Wisc.Admin.Code.
o Effluent fliter(sl shall be inspected every 3 yeara and shall be deaned when necessary to remove any
accumulated solids aa�rcfing to manufacturers spe�cations. A serviang period will always be greater than 12
months.
System malrrtenance reports shall be submitted to the proper local govemment unit In accordancs wfth
SPS 383.55 Wisc.Admin.Code. Report any eomponent fallure or malfunction to:
Name of individual or company: D811 BUfCI1 Pho�: 715.416.1642
�ocai go��rr,me�t u��r. Sawyer County Zoning Phone: 715.634.8288
Locai govemmem unit address: 10610 M8i(1 St. #49 ZiP: 54843
My 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 maHunctioning components shall comply w(th SPS 383,Wisc.Admin.Code.
No product for chemical or physical restoretion of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin.Code.
ConHnaencv Plan
In the event that any failed treatment component of this POWTS cannot be repalrsd,it shall be replaced pursuant to
a pian submitted to the appropriate agency for revlew and approvai. A failed in�round dispersal component may be
abandoned and replaced by e code-complying dispersal componeM in a pre-determined area of suitable soiis.
Svstem Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.
��%;t ��"`` PRIVATE ONSITE WASTE TREATMENT county
,�--' <<;=r�
'� � o$ ��� SYSTEMS
;-�, y
�;����PS i�;? ( POWTS) aw er
�"'""=''=�y" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 2 ^a-��
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)]
Permit Holder's Name: u t� �� ❑City ❑ Village Q�Town of: State Plan Transaction ID#:
n� I �,
S61C�, RJ' Co�,r� �o�S�1n ��cn �$5 �K-2�.� �—
Insp BM Elev: B Description. Parcel Tax No:
(6��o � N�� 11 o�t- P���- c�a-9yo-o -�ai S`
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,�,;e,�s ��Tj Benchmark �co,e'
Dosing
Aeration Bldg. Sewer 9Y,g�-'
Holding St/Ht Inlet �YY�'��
TANK SETBACK INFORMATION St/Ht outlet 9Y YS�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic .}�' N (o ,+�o� NA DtBottom
Dosing NA Installation
Contour
Aeration NA Header/Man. -�j 395�
Holding Dist.Pipe
PUMP/�IPHON INFORMATION Infiltrative q �
Surface 9�• -T
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 � L �;� � �(o' #of Cells Type of System Distribution Media Manufacturer:
OHWM of Nav Conv ❑ A re ate ��'�
SETBACK � gg g
INFORMATION P I L Bldg Well i/yaters � IGP � Chamber
❑ AG ❑ EZFIow Model Number:
CELL TO �o � � N ❑ Mound o Other Qyr
-- ----- - - - --��--- �__ _-- ------ --
- ----
DISTRIBUTION SYSTEM X Pressure Systems Only
—----
----- --
Header/Manifold Distribution Pi e s
p ( ) � X Hole Size X Hole Observation Pipes
Length Dia Length __ Dia Spac �_ Spacing ❑Yes ❑ No �
SOIL COVER
-- - — ----- -
------
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges � Topsoil � ❑ Yes ❑ No � ❑Yes ❑ Na �
C OMMENTS; (Include code discrepancies,persons present,etc.)
� �S��iei� I( (g� ��
Plan revision required?❑Yes ❑ No �3 (o �� ` �/,�;�%��__— �j�'/ � /
-- � b
�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADOITIONAL C�MMENTS AN� SKETCH
SANITAAY PEAMIT NUMBEA ___��--279 __
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