HomeMy WebLinkAbout024-741-30-1313-SAN-2022-297 �
'��''-'"��� Industry Services Division Coimty �
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-� 8 4822 Madison Yards Way SBWyef
- , S� - Madison,WI 53705 Sanitary Permit Number(to be filled in by
, _ ;�, P.O.Box 7302 c �
�� ``"�, Madison,WI 53707 � 3� � � o �j
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Sanl*a� PeY,l,nl+ Ap„71Ca+l�n State Transaction Numbcr �
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In accordance with SPS 383.21(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-o�vned POWTS are submitted to Project Address(if different than mailino
the Department of Safety and Professional Services Personal infonnation you provide ma}�be used for secondap� ������ �����+��� ��
purposes in accordance�vith the Privacy La�c,s l�_0 1(1)(m),Stats- ��
I.Application Information—Please Print All Information
Propert}O��ner's Name Parcel#
COREY R & BARBARA J ALLEN 024-741-30-1313
Property ON�ner's Mailing Address Propert}�Location
8967 COUNTY RD 3 NW co�t �.��
City,State Zip Code Phone Number
ORONOCO, MN 55960 sw ,,,,NE ,, seC,;�� so
II.Type of Building(check all that apply) Lot# 7�41 N K 07 E or W
�l or2 Pamily Dwclline—NumbcrotBcdrooms � 2
Subdivision Namc
Block#
�Public/Commeroial—Describe Use
�City of
�State Owned—Describc Use CSM Number �Village of
32/194 #7873 0�'�°����°'� R°�nd �ake
Ill.Type of POW"I'S Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check onc box on linc B.Complete line C if
a licable.)
�� �New S stem �Rc lac ement S stem �Other Modification to Eaistin S stem ex lain �Additional Pretreatment Unit ex lain
✓ Y P" ' Y' g Y � P ) ( P"� )
R' �Holding Tank �In-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain)
(conventional)
C• ❑Renewal Before �Izcvision �Change of Plumber �ransfer to New Owner
List Previous Pennit Number and Datc Issucd
Expiration ^--
1V.Dispersal/Treatment Area and Tank Information:
Design I�low(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(s� Dispersal Area Proposcd(st) System Elevation
450 0.7 643 652 93.00
Capacity in Total #of Manufacturer
Iank Information Gallons Gallons Units � ` U 'D„ �
U N i/,
Ne«Tanks Esisting Tanks y o a� � y � � �
c.. U v: � rn c�.. C7 a.
Septic or Holding Tank 1000 1000 1 WIESER CONCRETE ✓ �
Dosing Chambcr � � �
V.Responsibility Statement- 1,t6e undersigned,assume responsibility for installation of the POWTS shown on the attachcd plans.
Plumber's Name(Print) Plw 's Signa MP/MPRS Numher 13usiness Phone Numbcr
Travis Butterfield � — 652879 715-634-8176
Plumber's Address(Strect Ciry,State,7_ip Code)
14346W St. Rd. 77, Haywar , I 54843
VI.Coun /llepartment Use Only
� ( Permit Fee Date Issued Issuing Agent Si�nature
� Ap rov ❑Disapproved _
❑Owner Given Reason for Denial $���•� ( � � �� ��''�'
Conditions of ApprovaUReasons for Disapproval I �1� r�j�� r ,�� , / f
lo J ��a� ���° .� �
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I N o�$ �-�1�� oC� � � �oz2 _
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CS�o�-�— � 1 '�� � N�w ..wor�d � s(� �;�3Jv�r�� �a4���r;j=
(/_�71.�I�i�`•!T/'\L1n,"lS�•"�;�1=1i-�i '�,�
lttach[o complete plans for the sys[em and submit to[he County only on paper not less than 8 1/2 x 11 inches in size � �� r n �
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sg�-639s�x.o2ia2� NO R�FUNDS AFT'�R
ISSUE OF PFF;AA17
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
Allen
Owner Name(s): COREY R & BARBARA J ALLEN Phone: - -
Owner Address: 8967 COUNTY RD 3 NW Zip: 54848
Project Address: 10376N PHEASANT LN
Govt. Lot: SW �1/4 of NE �1/4, Section30 , T41 N-R07 E ❑or W ❑✓
Township: ROUND LAKE County: SAWYER
Project Parcel ID #: 024-741-30-1313
Designer Information
Designer Name: Travis Butterfield Phone: 715 _634 _8176
Designer Address: 14346W St. Rd. 77, Hayward, WI Z�p; 54843
E-mail: office@butterfielddrilling.com ����„ss�,�,�e,-e,er���dr���a��E�,��,���,r�,z,�,,.
License Number: 652879
Remarks:
------
Signature: . �-�_= _ .. .________ � Date: � I Z2
inal signature required on each submitted copy.
CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE.
SOIL EVALUATION sca�e: 1"=40' �( PAGE 2 OF
� 40 60 gp (i�J SYSTEiV1
SITE MAP PLOT PLAN
PROJECT NAME:
/'� / .��x DESIGN FLOW: �� GPD
C�p�/ `�'�.T/�' o4-l�eh Attach design flow calculations for commercial plans.
PROJECT ADDRESS: l U S 7�o N !/�1<'-�.5'a�� �h� Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
�O�.D IV SanitarySewer: �-4 y� /
BM Symbol: �- BM Elevation: F7
n�� �� a�u O�� ,� Force Main: /
BM Description: (��'
Slope Gradlent(o�� Indicate north 6y IMPORTANT:
of Tested Area; Well Symbol(Ifzpplicable): Q drawing an arrow Show ground elevation confours af suifable iniervals.
on the approprite line.
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37 ��, 5
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Septic Tank(s)Manufacturer
IN-GROUND GRAVITY DISPERSAL AREA WIESERCONCRETE
Uniform Elevation Trenches with Quick4 Standard-W Chambers SeP�;�Ta�k�s>�o,�me,s�
3-ft Trench (down-sizing credit) �oo0 9a, gal gal 9a�
Effluent Filter Manufacturer:
BEST
I
e�ri�e�c F�ice�Moaei# GF 10-8
(��.,z.
ryP�cap
SOIL COVER
12„
min trench
tleplh
c�vP��n • TYPICAL TRENCH
CROSS SECTION VIEW
34"
' �ryp,�a�� (No Scale) �
' � e° Provide minimum 3 ft
System Elevation— �j� ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap oeservano�P�Pe TYPICAL TRENCH
(typical) (Show location of Inlet/outlet pipe connection on plan view.) (ryp�=aq
�nstanpermanufacturers PLAN VIEW
instructions.
(No Scale)
� ----------��-------��--------- —� T
I . � .� . . I IA=3.Oft
(rypicaq '�
�--------�----��-------��---- -----� � D
� B= 64 ft � m
(typical) Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: �mtd ey i�nnrarorsystems,inc.) �
Install pursuant�o manufacturer's instmctions.
16 Quick4 Std-W @ 20 fl�EISA/chamber= 320 rt� �
+ � Pairs of end caps @ 6 ft�EISA/pair= 6 ft�
=Proposed EISA pertrench= 326 ft� Required Infiltration Area= 643 ft' Distribution Method:
x 2 trenches =Proposed Total EISA= 652 ft� branched manifold �
�
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 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 = 450 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 certified 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(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: BUttE,'I`f12IC� , � C1C. Phone: 7 � 5-63�76
�ocal govemment unit: SaW�/E,'I' COUCIt�/ ZOCIICtg Phone: 7 � 5-634'-H28$
�ocal government unit address: � O6 � O MaICI St. SUIt2 4-9, Hayward , U 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.
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 component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.