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HomeMy WebLinkAbout010-145-00-1500-SAN-2022-290 � � SAWYER COUNTY ZONING&CONSERVATION ADMINISTRATION � 10610 Main Street,Suite 49 y� Hayward,Wisconsin 54843 i (715)634-8288 � sanitarian;ir sa���crcuimheuc.m�a � COUNTY SANITARY PERMIT APPLICATION In accord with Chapter DSPS 383,Wis.Adm Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRINT Property Owner's Name Property Legal Description I�AIRIS TRUST DATED F[BRUARY 6,2022 GL 1 % NW%� SCC. 23 ,TN'P. 4I N,Range 8 W Property OwnePs Mailing Address Lot Number Bbek Number 10852 N_Linden Rd 13 Ciry,Smte Zip Code Phone Number Subdivisiou Name or CSM Number Hayward,WI 54843 �651 ) 341-2244 Linden Subdivision TYPE OF BUILDING:(Check one) State Owned Ciry Nearesc Road ����e�aa ❑Public ❑x 1 or 2 Family Dwelling—No.of bedrootns 4 ❑village Firc Numbcr — �Town of Hayward 10852N PUBLIC BIDLDING/LAND USE:[Expia��mc uuip�`pose�m m�s Parcel Tax Number:(l2 digit legacy number) permit.(i.c..campgroun4 festival.recrcation/encercainment evrnt etc.)1 Residen[ial home-Relocate existing sep[ic tank—10'west 0 1 0 -1 4 5 -0 0 •I 5 0 0 TYPE OF PERMIT: Additlonal Information: ❑POWTS Reconnection(SAN#_- ) ❑POWTS Connection (SAN# ) *Attach a Plot Plan with all required informatlon per SPS 383.21 �POWTS Revision(SAN#02 -20� ❑POWTS Repair(SAN# -_) *Soil Test Informadon(CST#_-_) �'Other: M��'F.twhen •Gallons per day RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for[he installation of the POWTS activity for which this permit is issued. Plum ePs Name:( �nt) ` Plumb ' re RSW No� Busincss Pryp c u�er� ��� (I�s�� 7 um s Addmss(Street,City State, p Cade): � b 2,1.2, � .6 3 11�; S y� 1 OFFICE USE ONLY: Disappmved Rcvicw Date: Pmnit Pec: Date Issued: Issuing Agent Signaturc j�Approved ❑Owncr Givcn Rcason for - S ���a� lo � 3� ��o ,c �ti��Z �U/.�h�..�.e� COMMENTS: **Expires 2 years from date of issue** Expiration date: (D �N �Oa�{ CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: �� � � a � '�.ia:r...._��-1.�_4. .°� . C+�.���Fi`ra�� Chk# 5�3u—. _ � hC:i# Ab�tNOrlcl Rev.04/2 U I S � �I 8u 3 NO REFJNDSAFTER IS3UE OF PERMIT K�t,e�s T2usT OM� F�e, 2ou (a85Z N L�N� � �,,,�,t�, u�= SYf y.� S_ ,y Tyr.✓ �28 '.c� LOT � S L/•�A�-r� SuBD. Ko�.n� l.�ke ��`/�'�j��~�'� �L-"'�.�`--�.i`�`—`."�— —~— _ �� �L— �._. N�( ��� � � Oas• �ay f/uLiC.akl a��tL05'�� Co,r�hc �7+P.T •� . +q9w z.,ecl � / �, ���, 6 � 4k.la i j�lEiil Lorajroa� _ ���� g,� /03..3;� � pF TkuIC � , � � �a2.d,� Y 1 �� / : � - \. __._.�.. . ....,�•:. ,�o a�� S�N �� • ���.,A m4:u e��,m Ne�Q� y 2'�a1L.� celts � �2�s roE,�l lia „_ � �;�len �� �py_J'� n� 1 5-tr�J v� ee�,� s�akc RS s 9a HT /o .s: 4� ��s�F�.n Eleu 4B f o2 to 46 3oZ �. ' � D,,�.� Rrtu�e�.l — � �X � ST�i�c� Po c,�7s � B-� Nlo.��F�� `� PRIVATE ONSITE WASTE TREATMENT SYSTEMS counry - 1SCOl�S�1� � PowTs� Department ot Commerce INSPECTION REPORT �"" ye'�' Saiety and Bui�dings Oivision (ATTACH TO PERMIT) Sanitary Pertnit No: GENERAL INFORMATION Oa — v'�0�7 Personai information ou rovide may be used for seconda u ses Privac Law,s. 15.04 I xm) Pertnit Holder's Name: p City O Village (�Town of: State Plan Transacfion lD#�. �ob� 51^; ��e K a 1p:e.l �a wct�o� CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: �oo ' -!� � i " � P� . s-�k�. o�o- +tis-oo- �soo TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �j{��}V� loZ SO Benchmark � 1Dl.a � LaO.o � Dosing �/ 7SO Aeration Bldg. Sewer tl ,1 ` �p, ' Holding St J Ht Inlet � , � ' , � ' TANK SETBACK INFORMATION st� Ht oueet I ,S ' gg,�g ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic ?�� fi �(o� 4- � �' � NA DtBottom ►b. y ' $y•g$ � � � Installation Dosing ;�p .(�O' k3jr' .l'35 NA Contour Aeration NA Header/Man. I �? � $ ' Hoiding Dist. Pipe PUMP I SIPHON INFORMATION Infi�trative Surface Manufacturer Demand Final Grade ti Model Numper � � y�/� GPM � � ,�7 � 9 g.5�� TDH a, ft Fricbon Loss .Q System Head TDH�;� t � a ,3. 1 ` 1$ � Forcemain Length ' Dia 2�� Dist. To Well + p� � 3 3 • I � 1 ' � DISPERSAL CELL INFORMATION DIMENSIONS wdtn 3 ' Length� �Io of Ce��s 3 Type of System Manufacturer: LEACHING y„�1�� SETBACK OHWM of Nav INFORMATION P � � Bldg We11 Waters CHAMBER ��v / Model Number. �� L1 CELLTO � YO -a-�a� ' +lod ' -t �00 � � �l� �ri DISTRIBUTION SYSTEM x Pressure Systems On�y Header/Manifold Distribu6on Pipe(s) X Hole Size X Hole Observa6on Pipes Lenath Dia Length Dia Spac Spacing ❑ Yes ❑ No SOIL COVER Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edqes Topsoil ❑ Yes ❑ No O Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.j Plan revision required?❑ Yes 0 No �$ \3�paJ `� WQJ� '" " '� � 1 b ! b Use other side for additional information Date POWTS Inspector's Signature Cert No Bureau of Field Operations, PO Box 7302, Madison, WI 53701-7302 SBD-6710 (R.3/01) — --_—--_ _-__- SEPTIC TANK fi PUMP CHAMBER CR�SS SECTIOM AtJD 5?ECIFE�RT_��?tS : 4" CI VENT PIPE 12" MIN. ABOVE GRADE b NEATHERPROOF � >Z5� FROM DOOR, WINDOW OR JUNCTIOII BOX APPP.QVED FRESH AIR INTAKE � �WITH CONDUIT Mr1NHOLE COVE fINISHED GRADE 'a/ p.ADLOCK 6 +t" CI RISER WP.RPlING LABE �—_._..�4" MIN. 18" IN. 6" MAX. �* :� ?NLET �— ��� � - � �, WA'fER TI6HT SEALS �S' � � T TIGHT� �� �qppROVED A SEAL � ; JOINTS NITH APPROVED -�- i ; ALM APOROYED PIPE PIPE 3' �- � �' ON 3' ONTO ONTO SOL1D � SflLID SU1L SOIL pUMP OFF ELEV. FT. -�- � � OFF °iY RISER EXI D PERMITTED ON IF TANK MAMIFACTURER HAS APPROVAL 3" APPROV£D BEDDING UNDER TANK CONCRETE FAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTIJRER: 5�f a u./ NUMBER DOSES PER DAY: '�� • TANK SIZES: SEPTIC ��,b GAL. DOSE VOLUME INCWD?NG DOSE �lso GAL• FLOWBACIC: /� a _ GAL. A4ARM MANUFACTURER: ��`'�a. �(Gl�ti�" CAPACITIES: A = a,f INCF::.S = �/,��GAI MODEL NUMHER: ipf SWITCH TYPE: _ lrl�t�c� B = 2 INCHES = �,�GAt PUHP MANUFACTtIRER: d u/Ie C = �(_ INCHES = �ffs'�6AI MODEL NUMBER: �no 9 SWITCH TYPE: nrttw��- D = _� INCHES = 9X,FS5GA? REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WF VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIP£ . . „_,�„_ FEET ; MINIMUM NETWORK SUPPLY PRESSURE . . . . . 2.5 FEET ♦ ,�,o Q FEET FORCEMAIN X ��,FT/100�FT.�FRICTION FACTOR�. FEET TATAL DYNAMIC HEAD =, ,�a��FEET IN�ERNAL DIMENSIONS OF PUMP TANK: LENGTH G '� � WIDTH tS'�• ; DIAMETER LIQUID 39'� . �G.Y%�alp„A.��a� SI6NED: LICENSE NUMBER: y�a�I,�_ DP.':E: ��__� 1/88 . '� � i�ab t ��1, , ��e�, 1��,(e� l ,C�� �6�60� 1�« ke R ��PS� ��. 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