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Home My WebLink About010-277-00-2200-SAN-2022-302 1 � -:�j�i=�`"'��;; Industry Services Di��ision County � /�,' ;;:' � ��,;, 4822 Madison Yards Way SBWyef � �:I ,, f� ;- Madison,WI 53705 Sanitary Permit Number(to be filled in by('� ; j � P.O.Box 7302 � �:'+:y-`'—:-'�`l Madison. WI 53707 � 3 q a�3 Q� <.��..�_ SCinIL`Gl� Per11111. AppllC`C�l.l�n StateTransactionNumber W In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmcntal unit Q is required prior to obtaining a sanitary permit.Note: Application fonns for state-owned POWTS are submitted to Prqject Address(if differcnt than mailing ad � the Department of Safety and Professional Services.Personal infonnation you provide may be used for secondap� �� R�� p�� p� purposes in accordance H�ith the Privac}°l.a�c,s 15.01(1)(m),Statti- ft f� I.Application Information-Please Print All[nformation Propert��O�cner's Name Parcel# NORDSKOGEN LLC 010-277-00-2200 Property Owner's Mailing Address Property Location 1175 FARWELL DR �o�,� ,�, City,Statc Zip Code Phonc Number MADISON, WI 60833 '�� '�, S��t�on '9 — iI.Type of[3uilding(chcck all that apply) Lot# T 41 N R 08 E or W �I or 2 Familc D�celling-Nuinber ofBedrooms 3 ______ Subdivision Name sio�ka HATCHERY CREEK SUBD LOT 22 �Public/Commeroial-Describe Use ❑City of �State Owned-Describe Use CSM Number �Village of ��r��„of' Hayward _ III.T��pe of PO«'TS Permit: (Check cither"New"or"Replacement"and other applicable on Iine A. Check one box on line E3.Complete line C if a licablc.) '�� Ncw S stem �Re lacement S stem �Other Modification to I:xistin S stem c� I iin �Additional Prctrcatment Unit ex lain ✓ Y P" Y' g Y' ('�'P� ) ( P ) B' �t lolding Tank �In-Ground �At-Grade �Mound �Individual Site Desien Other Type(eaplain) (conventional) C. �Rencwal Before �Revision �Change of Plumber �IransCer to Ncw Owner List Previous Pennit Number and Date Issued I:xpiration IV.DispersaUl'reatment Area and Tank Information: Design Flo��(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Reyuired(st) Dispersal Area Proposed(st) S}�stcm l:levation 450 0.7 643 652 92.00 Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units � � v � � Nc�ti�l�anks Eaisting Ta�il:s � c � � � s � � _ c — _ :� ✓: v: v; ._ .: . SepticorHoldingTanl: 1000 1000 1 WIESERCONCRETE ✓ � Dosing Chambcr � � � V.Responsibility Statement-I,the undersigned,assume responsibility for iustallation of the NOW'CS shown on thc attached plans. Plumber s Name(Print) Plw r Sienature MP/MPRS Number [3usiness Phone Numhcr Travis Butterfield -` --- ------ 652879 715-634-8176 Plumber's Address(Street,C:ity,State,Zip Code) 14346W St. Rd. 77, Haywa , I 54843 VI.Coun /Department Use Only 10 l7 Pennit Fee Date Issued Issuing Agent SignaWre �App ov ❑Disappro��cd , ❑O�wier Given Reason for Denial $�� 'a � �� Conditions of Approval/Reasons for Disapproval --- de�;-��` - , � -�� - ► � f��J�a �� t, �,n,� _ _ � .� .- ,� .;.� _ - �� ' �i�► , a o�-I cl ��,��; qq . L � �+�`� °— �.:�_� C��t� � � ��C4 i_ C� 1 _ �� - /°'� I � -'� ` IJ e-t� _�L.pY'�c� �.3 C�LO� ;------..--�......_--—? M f� °''�WYE�-�i COI��TY ��1��at��!49lPJISTf��f�i li)t� :�ttach[o complete plans for the s}stem and submit to the Counh�only on paper not less than 8 I/2�11 inches in size L 3 �� j _� �� NO RCFJNDS�FTER sB�-639s�K.oaizz> I�SU�OF PE��AI'� PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description NORDSKOGEN LLC Owner Name(s): NORDSKOGEN LLC Phone: - - Owner Address: 1175 FARWELL DR, MADISON, WI Zip: 60833 Project Address: 14530W BIRKEN TRAIL RD, HAYWARD, WI 54843 Govt. Lot: 1/4 of 1/4, Section �9 , T4� N-R O$ E❑or W ❑✓ Township: HAYWARD County: SAWYER Project Parcel ID #: 010-277-00-2200 Designer Information Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176 Designer Address: 14346W ST. RD 77, HAYWARD, WI Zip: 54843 E-maiI: OFFICE@BUTTERFIELDDRILLING.COM �i�l,;;��,a��z�e,�,v��f�r��,p1��1�<<�n,;,. License Number: 652879 Remarks: Signature. , _ .....�_ _...__ . . Date: �:� i �Z Original gn ture required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK HOX AS APPLICABLE. ❑ SOIL EVALUATION Scale: 1��=40� � SYS�TEIVr PAGE 2 OF SfTE MAP D 4D 60 80 PLOT PLAfV PROJECT NAME: �pz DESIGN FLOW; �� Gpp �`�r�s�`"�� L�C Attach design flow calculafions for commercial pfans. r / PROJECTADDRESS: I�S3D � 13�`rv�„t �Y`/zi; �— � n' Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5) BM Symbol; � BM Elevation: /�'� �- 'V `�, Sanitary Sewer._ 1 � �� / p Force Main: / BM Description: ✓�� n a y��G�/l�: � Y��1� ' Slope Gradlent(%) lndicace nu��by IMPO RTANT: of Tesfed Area: Well S}�m6ol(If applicable); � drawing an arrow Show ground elevation confours af suitable intervals. on the approprite line. � ��.y� ^ /C�C7.l� 1 � 1 �� L �� ,2j '�7(� � �I � \ 2� �'�r� \\ ` / 1 i �w � -�'�e-� /YS3n c.v � ------ � � � �� ) I J`u�'- —�-------�, � I � � I Yv �y h 5�t �f� l`�a`�j 2 � ( ��;y< � � / / f <�� I G.�,<:3.1'C" ,,,�_;� �s�� °z a��%'/ obf ,�� (s�u.tct4 c( �,�s c-Lc.�a--�� , � � t��sf- �� C, ��-�� ,7,FS S�.l �'w g. 3 �i � ,c d _ _ � ,,__ - a J`5 �.�K��7TG . �►°RS ��"'�zs'�9 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) �000 gal gal gal gal Effluent Filter Manufacturer: Best � E��enc F�iter Modei�: Gf 10-8 min.1z" SOIL COVER (typlcal) 12„ min.hench depth • criP��a�� '� • � TYPICAL TRENCH - � • —- � �� °��a �•. CROSS SECTION VIEW � 3d„ •'• a, .. , . <<Yp��a�� :�, . . . (No Scale) n a• ' a . • ° Provide minimum 3 ft System Elevation —92•00 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap Observation Pipe TYPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (rypical) Install per manufacturer's PLAN VIEW instructions. �NO SCB�@� � - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - - -� M � � ,.' , ; I �A= 3.0 ft ' " . (�'Pioaq � � - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - � D G� B = 64 ft -� m (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typical) Q (mfd by InfiltratorSystems,Inc.) � Install pursuant to manufacturers instructions. 16 Quick4 Std-W @ 20 fP EISA/chamber= 320 ftz 'A + � Pairs of end caps @ 6 ft2 EISA/pair= 6 ft2 = Proposed EISA per trench= 326 ftz Required Infiltration Area= 643 {tz Distribution Method: x 2 trenches = Proposed Total EISA = 652 ft2 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 38352(3),Wisc.Admin.Code. Maximum Dispersal Area Operatinq Limits: Design Flow= 450 9Pd; BODS 5 220 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 priorto 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 cerfified 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 deaned 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: BUtt21�1@ICI, I11C. _Phone: 7�5-634-$�76 _ �ocal government unit: SaWy@I'COUIIt)/ ZOIIICIg Phone: 7�5-634-828$ _ �ocal government unit address: �OG�O Malfl St. SUIt@ 4J, 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. 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 soils. SYstem Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. '"�"''"-T`'E''�� PRIVATE ONSITE WASTE TREATMENT county ,y�"- ,,. %i' r�. ��'� o$ �j�, SYSTEMS �.\�,��S �. ? ( POWTS) Sa.Wyer \A�Tss�<�r/ INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � � _ '� O 2 Petsonal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Viltage �Town of: State Plan Tra�saction ID#: 1 v��5 L�-��h L.L� �a w a�'�1 Insp BM Elev: BM Description: Parcel Tax No: �v D.�� 1 v a� `� �c.( �� (.��'�� `t'��_ �1� -�'�?-�O -- a�O't, i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,,,�Q�- �porU Benchmark �pU.D� Dosing Aeration Bldg. Sewer `t7.�' Holding St/Ht Inlet R 6.� � TANK SETBACK INFORMATION St/Ht outlet 9 S$ ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE septic +�' N 13� fii 3' NA �t Bottom Dosing NA Installation Contour Aeration NA Header/Man. �t 3.`i Holding Dist. Pipe PUMP/SIPHON INFORMATION Infiltrative �a Q � Surface 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 �N 3 L � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate ��` INFORMATION P/L Bldg Well Waters ° G �C Chamber Model Number: ❑ EZFIow CELL TO �4-�b �I'� N N ❑ Mound o Other `�,t.� _ _ ___— -_--- -__--- - DISTRIBUTION SYSTEM X Pressure Systems On�y Header I Manifold Distnbution Pipe(s) X Hole Size X Hole Observation PipE+s Length Dia l_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 ❑ No - --__ _ -- � COMMENTS: (Include code discrepancies, persons present,etc.) ��-�l(�p 5-�3� � � 3 Plan revision required?❑Yes ❑ No d� �� Z Y � � � — 6qs'� (/ � b Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBEA: a-'oZ - 3�� QY.� x�� a � • ' . . _ � ; � '—� ',,5� �.aM �' `I��l, 2� �.�' 2� 6�;c . i3' � �^ �aoo T �� ' `��T� >' i3� � � � u � f�� I I G��Q � � I�s�,� -�-�;I �a. `�� `�" -�--