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HomeMy WebLinkAbout028-742-27-5301-SAN-2022-311 �, "'� . Department of Safety cOU°ry C� � 6 & Professional Services, " �� � S' - Sanitary Permit Num er(to be filled in by � : Industry Services Division � Cv��� '�l � "t i q� Sanitary Permit Application State Transaction Number � In accordance with SPS 383.21(2),Wis Adm.Code,submission of th�s form to the appropriate governmental unit �S ' j0 LZ OZ�P�r — L (� is required pnor[o obtaining a sanitary permrt Note Application forms for state-owned POWTS are submitted to Project Address(ifdifferent than mailing a .� the Department of Safety and Professional Services.Personal information you provide may be used for secondary ? purposes in accordance with the Privacy Law,s. 1�.04(I)(m),Stats C���C� � �;�5 (�� Q� I.Application Information—Please Print All Information Property Owner's Name Pazcel# l,l�a.�� e a-� o�� �v� ,s LL�- 62�-'1 c�'L-Z7-s36/ Property Owne ailing Address Property Location Z 22 f' � . P a( �� �V� • Govt.Lot�_ City,State Zip Code Phone Number C-�G-Q�C� , S� ��� Y � ?IS-SSSr'3'73� ��'� '/., Section a-7 II.Type of Bu ding(check all that apply) Lot# T Z IY R ❑ i or2 Family Dwelling-NumberofBedrooms SubdivisionName �" Block# �Public/Commercial-Describe Use`-Q--�� ❑City of ❑State Owned-Describe Use CSM Number ❑Village of {'�Vt'1" � • �. � '�Town of�+dC�(� � III.Type of POWTS Permit: (Check either"New"or"ReptacemenY'and other applicable on line A. Check one box on line B.Complete line C if a licable. A. ❑ New System �eplacement System ❑ Other Moditicat�on to Existmg System(explain) ❑ Additio�al Pretreatment Unit(explain) B' ❑ Holding Tank �n-Ground �E' ❑ At-Grade g yp ( ,p � ❑ Mound ❑ Individual Site Des� n ❑ Other T e er lam (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to Ne�c Owner �st Previous Permit Number and Date Issued Expiration q`� � �Z J IV.DispersallTreatment Area and Tank Information: Design Flow(apd) Desien Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sf1 System Elevation ��� .u7 /Zk(, 13b6 QS'��� Capacity in Total #of Manufacturer Tank[nformation Gallons Gallons Units � ` o � _ tiew Tanl:s Existing Tanks •L � y ` y D � � 0 a U �n � v, i� C: a. Septic erffoM*wt,Tank /v,� f!6 p0 �� �^ Z �(GS�I� Dosing Chamber .Z�� ,�`C C � �� . V.Responsibility Statement- I,the undersigned,assume responsibili for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature , MP/�F�S Number Business Phone Number ,�-�"�: ,.+ �LlSd�1 �K��++�< <������ i��s�si ��,s- 7s�-.��rs� Plumber's Address(Street,City,State,Zip Code) � �'� �t� , �%�x �� . CCc��.�-, w Z ���� VI.Coun /Department tise Onlv � a � . Pennit Fee Date Issued [ssuing Agent Signature r ved ❑Disapproved . � l'�O�,� ! �; 1: I i � �- �'������uvt,^a ❑Owner Given Reason for Denial Conditions of ApprovaVReasons for Disapprovaf D �f�;f(,Il i i `,,�., ` ` `' ate � � � 3 I ��a �,., {�_,�, �� ;: ,� �;� � 3�`�s OCT 2 0 �022 ���� ' �k# � ; _.. � ; ,.�fi�t IVe� `W�r �d � 3��� _________- ., -- ,-�,- �.- � <. _ ... _ .... SAWYEt� ,, L �S � p� _ /'� `� ?J ,�1;1 ZONING AQr�?! � ,� ', ��'v Attach to complete plans for the sys[em and submit the Counh�onh�on paper not less than 8 t2 x I1 inches in size � >> i [�`'� ..i. NO REFJNDS AFTER SBD-6398(R.03/22) i�UCO�P��tt `���� DIVISION OF INOUSTRV SERVICES 105C1 N R/1NCM RO _" 0 _ w.rwnRowi s/ea3-saez Contacl Tnroug�Reby �� S P S, � nrco//�sys.w�gov/programvinOusvy-services www wisconsin.gov ;.,,i..i�.... .� Tony Evan-Govamor D�wn Crim-Sacrebry Odober 18, 2022 Condifionally APPROVED CONDITIONALAPPROVAL �ePT ocsaFeTrnNoaROFessioN�� sERvicEs I�iviSi(�ry OF INDUCTRY SEkVICES PLAN APPROVALEXPIRE5: 2024-10-18 � � Plan Review: PWTS-102202606-C Jason Kuettel �FFcokRrsuounrNce 42940 US Highway 63 Cable, WI SITE: Wanegan Holdings, LLC 10970 W Boys Camp Rd Sawyer County Town of Spider Lake 527—T42 N—R7 W FOR: Description:-900 gpd DWF system size 65" In ground Component Manual—Ver. 2.1(May to limiting factor—Effluent Filter- 2022-2027) Maintenance required Domestic wastewater only. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above, The owner, as definPd in chapter 101.01(10),Wisconsin Statutes, is responsible for tompliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to octupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis.Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. ias.zo(z)(d�, w�:. scac:. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A_c_opv of the aoproved olans specifications and this letter shall be on-site durine construction and open to inspection bv authorized reoresentatives of the Deoartment which mav include local inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuringthat POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54�1�. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acteptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ,J'a�ucw/2o�ul�y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 813-9111 Joshua.rowlevC�wisconsin.�ov �� ., _ - �- . � . . . . . -; . _ . ___ .._ _ �c�a t�n� + a s��cli6��� �^ot���r : .�.�.��:�,U0.c�e � �b�c�c� s ��C ,,,.� z4(�o� -- �— ��--�--- _. ��<<,^,��� ��a1ec �n s c.t.c ' -- --�_— — �DDF��i 2Z2U l,U, {�ledifl F}ve. ��-IC�J� .S, L l��y 7 PHO<<E �1S -s�k - 373L PE:QJECT' AUDP.ESS: _ I_�_�`I O VJ _ �Uy,S C��� �il , — _f _� _ _4-����Q wr s�`E��,3 � E�� 4L C��_`��'R (PTI� i;;� S37, l`'fL N, 1L76J (, L. 3 -------- �w�� of S �c�er L�ke -� ___ _--- SQ.w e�' �� .�r_— — ---� -- - PARCE[. i(Uiv[BE[:: (�[c.��--°_3. �__--(y28 - r1`f2 -27- 5�3b � i. [NDEYSHEE( _'. F'�.0 1� FI.Ai I Conditionally _ SEPTr�YI'u��.1P rA�rf: c[;oss-sEcr[o�l APPROVED DEPT. OF SAFETY AND PROFESSIONAL PUi:IF' CIII;V[�, seRvices DIVISION OF INDUSTRY SERVICE5 i. CELL. L;',YGUT � C[:OS . o. SOlL EVALU;1'f[Qy �.ea.�.v.r �e,�tG� ?. SOfL TES1'GR PLOi� f'I. S� � ��- SYJ1�Gi`.'i l LP�'. VCR1�1 � � s�F <.nkkrs�oNnencF � , i � li '.! il , . Ii � , ; � � , � �I' (a�57S'1 la/�/zz 1o�as p r l,�la�ne�a,� ��I��n�'s ��C � T�uKCs) ,P�sr � Z2Z� w . (Vled�� lt flde_ P��%,`-� , .� S� Tre�,cH Ch ICQCIQ r (.. �c0(n�{r/ Forecemain to be minimum of 90'�deep to t pipe to �Nstem P�-�'i J Cry1 S) S5 8- 3'7 3 L Prevent freeze up. �(� � PL�q�aiE ��� Sep�Son�� IGQ�t� W C?�o s C�4MP Rc� � �� (-w� r'=) � (,vz�an�- �- * lcoo z P��y ; z7 , � �fZN , 2 'iw �D onG/Ld�'-�) /' fvr�en,a�n �Scred� ToW,1 0� SPIQe� ��<�, ry I I �r5o'�lDra�� bn�k 1 i P�P -t�^k J �~aw�.er- �o , ��-r � � �? ��� Re�ocafec� �q_� i_D �' 30 � C�.L, � 3 Pe�� SfuR czE 7� 2 - 2?- S3o( / � � �° ��l\ �� 6mZ = a`� ZS` � � o� Wel ( � i '�' s�Hyc s1aFF ' � � � µa� �Sea.4mal li+iesE� l000 � r w/er��ct u SE � (kr O K1�-�� ���:c��cl Bu� Idcz�9 s�;�.F . j Sexti�c-t>j e(e � _ �G .O � * � ' N��e t,�,�,esEQ z�cr I�w P.cF(z �---�• �.�c� �, P�p��d R�� � F��.rf, ��„� �,���ss �d � �� = �s.3 � � ° � ��esea � �' ioco s r. W/ . 1 Ove-y��,y iTo6a2 ��� �'�Scti �i l�.Y' � _ . yo �— � � _. �� /� �— WE.IL � �\V �. G3R �� � \� i � \ / elzu = ��.7'i -' � C1us�rny 3l;R Nome a � �''iv�tfe 1��r�ue �-o �q�Lb�2z� P✓t%�c5e� 3132 Nei-1,' BC� S �Q.'Y�Q �� , �� �h1E 1V1 SR.me. J � �����t � ,� ��� .���� � ; �_ �� �Q.Sb V� �u z�"e� = � V�A,(���ZS�51 i - �0�31 z2 I �� � PAGE40F5 GRAVITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) d"0 Venl Pipe .10 fl fmm BudGmg Oeql.�cai m,isi wi�py�nP- _ 12"Min o�20tlabove SPS316a"�oNEC300 Es1a���sFeC Fi�BevaLo�� WeatM1e�oroo� F[Ienc manM1o�e nser as necessary (No��ap �ur+ctio�Bor APP�oveC Vanl CaP APProved Lock��.rg Manhole I MPORTANT: I v ir wam�`YP�ce�i AuaUad Anchor tank(s)as necessary `c�,� i � pursuant to SPS 383.43(8)(g) a^M��.o�z o n aoo�e EslaOiisned Flood Eleval:on (bPical) �Ai�iS�l Sea '. F�i5hed GraCe � _ � QucN DisfAnnCCI 18"FAin CAPACITIES @ �� �'7 gallin � °Yo'�' Depth(in) Volume (gal) • a ! I cn tl ic— A 2�±:J �20�! . p � WeaP �APPmvedJa�nlsanlh Hoie AporoveE Pipe J fl onlo B 2.Q �f1, s� q SolidGmund (�YPi�'al) �C) 2. 5 i4e .�5 � � 0 Aa,� � e -- :'s_ll��.t?� (���V'411� `, D /O S1��.7 �—o� � �c� PUMP-0FF * �^ ` P'""'' 0_0�� ELEVATION = �'-S. 3 ft ± Pump Tank Liquid Level =�S�in ( " ° INSIDE BOTTOM Force Main Diameter = 2 in `'°"""'e � B'°°" ELEVATION = �Sj� ft '- C �S'A�Oved Bedd�ng Maiena F3e�'exlh ian4 Force Main Length = SD R (1re:in �;cE � � (rcc � ���4�,1 (dc,��d� J -{-r��� z�� � ��� ss C� So � 1.a5 ` TDN Force Main Void Volume = �'� /$ gal �z�� �' Sa �'��� s ��"�' J�.^�-. (_iF+ /o. �c [C] Total Dose Volume TDV = j,zC . 4 S galldose �" �POk S f�e,^ �Ciu_ = 1/Z� S �a� /�C� (<02X des�yn(low+lorce main void volume) (��US � v'�RG(C 900x.2=180+8.15=188.15 Max Vertical Lift = _ �Q : �7__ tl �bidni�o �Q = 46� ,(� - k�, 3 (pau,� � c'�� =b�ur�t �' (��Y � PUMP TANK: SEPTIC TANK(S): Volume = 2C,p� gal �2tqg �{ ���-{ual� TotalVolume = IOOQ gal ' ="� ManufacWrer: � �E�r(� Manufacturer(s): �' �E 5E (� PumpManufacWrer. ChClvYiO�C(1 '; ��kal`�r._� � Install approved effluent filter al the seotic tank ouUel Pump Model: !' d�E S5 �Seea1�a�,�o�mp��,��� immediate�y upstream of the oump tank inlet. ControlslAlarm Manufacturer. S,�E Filter Manufacturer. 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P���i� i'r1 � �l_Cu(� � �'i�I �� i"��t1'� r ltC.i� ,�` �`',� ��� ,����22. � •. ` t _. , _ ` _ . , . , .; >... q CC�1 C��. t� -�.,��� �'i��`) c'�-� _� (1 t' [C c.( t�� ky.l�U. �`�.-�� °, C•{�Y"�.v�'=v' -.�"�l�i"1 �r�'�' 'C`V'�'v'rtl �i"P`<:.''�il�f� :'i `��f ��r:d :.�� \ ',`'�'�'"�^ PRIVATE ONSITE WASTE TREATMENT county /% =r � �, ��;; osP \`,�,; SYSTEMS Sawyer `�:��1 s,��'' ( POWTS) \�'t�F�y�-i�E?.. ' '"-=`'='' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION ��r3 � ( Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village I�'Town of: State Plan Transaction ID#: tn�� Q�, �o\c�2� ��L S ;� C.q(� �P'^'�3-co a„�a�6a6 -� Insp BM Elev: BM Description: Parcel Tax No: �°O-� � � �t 2 �o n-► a� �s��; .11n.,� aa : ��,� o�-$-�Y� �-;2-7• �'3 a1 TANK INFORMATION � �. � s ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic z W� � ��p Benchmark� pp,�' Dosing �..�i 2 A� oZ�D (jn1 a �� �j y�.2S' Aeration Bldg. Sewer - Holding St/Ht Inlet ,4r � TANK SETBACK INFORMATION St/Ht Outiet � TANK TO P/L WELL BLDG AiRiNTAKE ROAD Dt Inlet Y.� ' Septic .�j'a` .��. � .�� < < NA Dt Bottom gl,$�'"� Dosing �< « << � NA Installation Contour Aeration NA Header/Man. 9 ,$ Holding Dist. Pipe PUMP/SIPHON INFORMATION Infiltrative surface �`r�a � Manufacturer 2, �9� �h � � Demand Final Grade c77 p� Model Number � �"" GPM ST �N �5:.?5 � TDH � Lift Friction Loss Sys Head TDH Ft ,�j'� p.,T- S.as Forcemain L � � Dia �'' Dist.To Well �j(,.� � DISPERSAL CELL INFORMATION DIMENSIONS W � L o� cpb� / #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate P I L Bidg Well � IGP ❑ Chamber INFORMATION Waters � AG � EZFIow Model Number: CELL TO ��j� � � ,�- ❑ Mound o Other - -____ - - --�' _-- `�— _ - �----- -- --- DISTRIBUTION SYSTEM X Pressure Systems Only --- — -- - Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia__ _ Spac �__ Spacing ❑Yes ❑ No _ SOIL COVER - - -- _ _ — - -- __ r Depth Over 1 Depth Over Depth of Seeded/Soddetl Mulched � Cell Center � Cell Edges I Topsoil __ ___ _� ❑Yes ❑ No � ❑Yes ❑ Pdo COMMENTS: (Include code discrepancies,persons present,etc.) �"��lL� la-��-��� Plan revision required?0 Yes 0 No � , 6� ��� � v3 I 3 �-3 ����..,. 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