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#
� ; _..
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,.�fi�t IVe� `W�r �d � 3��� _________- .,
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� <. _ ... _ .... 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
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_ 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
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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. C�v<:�(_�
Controls/Alarm Model: I � I H �
Filter ModeC f� l �- �� �
Float switches containinq meroury are prohibited.
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',`'�'�'"�^ PRIVATE ONSITE WASTE TREATMENT county
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��;; osP \`,�,; SYSTEMS Sawyer
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' '"-=`'='' 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.)
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Plan revision required?0 Yes 0 No � , 6� ��� �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIONAL COMMENTS ANO SKETCH �
SANITARY PEAMIT NUMBEA:_ ��"-�Il__ �� }� �o
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