HomeMy WebLinkAbout014-842-17-2303-SAN-2022-314 ����'"'''`�% Department of Safety c°°"�' �
- � � = & Professional Services, S � �
, _ _ Sanitary Permit Number to be filled in by
� � �� �s Industry Services Division
, . _ � 3 �j �q3 �—'
�-. �. .� �
�,., . ;�.
r,,.�,..,�.
Sanitary Permit Application c�
State Transaction Number �
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit �
is required prior to obtaining a sanitary permit.Note Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a�
the DepaRment of Satety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. �3 5 0 a N S�M�n S�w
I.Application Information-Please Print All Information
Property Owner's Name Narcel#
1� .�l + (,arol y dJ -85►�- /'�! o� 0 3a0)
Property Owner's Mailing Address Property I.ocation
SO N �mcN+s (Zc� �d��.�c N�,.1
City,State Zip Code Phone Number r4r� 51'2 �
HC� WG�P C�� w= �J" �'/�y� _�%,__�__%a, Section �7
I I.Type of Building(check all that apply) Lot# T y N R -�o
,�1 or2 Family Dwelling-NumberofBedrooms O -' Subdivision Name
�-
Biock#
❑Public/Commercial-Describe Use —
❑City of' _
❑State Owned-Describe Use CSM Number ❑V illage of _
�7'Town of L c n C'o c7i' _
III.Type of POVVTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C i
a licable.
A.
❑ New System �Replacement Sys[em ❑Other Modificat�on to Existmg System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank �In-Ground ❑ At-Grade
❑ Mound ❑ Individual Site Design Other Type(explain)
(conventional)
C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Pertni[Number and Date Issucd
❑Transfer to New Owner �
Expiration �v�u� ,
IV.DispersaUTreatment Area and Tank Information: v; y� �1v w...,bt u+� SC/^f OFC it�
Design Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(s� Dispersal Area Proposed(st) System Elevation
300 0,� Y�9 `/ � •av �
Capacity in Total #of Manufacturer y
Tank Information Gallons Gallons Units � � o ,�, �
,f3 U
v
New Tanks Ezisbng Tanks ` o � F y � �a c`�d
0. U V� r"n V7 I-c. Ci 0.
Septic or Holding Tanlc � �, ' •� �. O n �-� X
Dosing Chamber
V.Responsibility Statement- [,the undersigned,assume re osibility for i stall 'oo of the POWTS showo on the attnched plans.
Plumber's Name(Print) Plumber's gn re MP/MPRS Number E3usiness Phone Number
► �soc �3oa3c� ��s-G3y-16'r
Plumber s Address(Street, �ty,State,Zip Code)
I C.aza S �3 �-�a �4�a Wt s��aY3
VI.Count /Department Use Only
10 ¢ Permit Fee Date Issued Issuing Agent Signature
�Ap o d ❑Disapproved L� „
�Owner Uiven Keason for Denial $ L�`�'•� �C ( 3� I�c� ^
Conditions of Approval/Reasons for Disapproval �}� ,���
'd.l_31���___ � � �_,.�}�, ,_! �_;, i! ,,
�' ' �� ��.j ,ti.�, �. — ^T�� � !'
•:hk#�._`�!�._ -- �—a1_ �CT � 0 ,e
,
C ST �� - '��S _, . �� �,.�_.����.��--�----------
Attach to complete pl9ns for the system and submit to the County only on paper no[less t6an 8 1/2 x I1 inches in size I -7�G ,
1
NO R�FJNDS AFTER
SBD-6398(R.03/22) I�Ue OF p�M�.�
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version�, SBD-10705-P (N.01/01, R. 10/12). -.
�. �
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
Anderson - Simons Rd
Owner Name(s): Paul & Carol Anderson Phone: - -
Owner Address: 13502N Simons Rd; Hayward, WI Z�p; 54843
Project Address: 13502N Simons Rd
Govt. Lot: Nw 1/4 of SW 1/4, Section �7 , T 42 N-R �$ E Q or W ✓�
Township: Lenroot County: Sawyer
Project Parcel ID#: 014-8412-17 2303
Designer Information
Designer Name: Ray Visocky Phone: 715 _634 _1679
Designer Address: 16222S Hwy 63 ; Hayward, WI Zip: 54843
E-mail: visockYPh@9maiLcom . ; ,:� . �,.. . �.,�� ,
License Number: 230236
Remarks:
,
Signature: Date: `� -� ��
Original signature req i d on each submitted copy.
a � o ��
� � � ,o �
O ^� � � A� ° °
�- ,n d r � � ,,,r° o� /DI
�'
. Q z o a �.. °' �+
— � E T � � p �e � ��
tl i � � �' �y �J 7 �
w 3 �- � cr `p
� � L• T
� � Q „ �- 2 � � M�
cVl� ° �-� 3 � � 6 5 a' P'a�
- r�l Z y �,.,N 0. Y1 �
0
�
�� �� �
.�
a � d
ps y�Pa4 A b d
� L s�1v�'rY C� �r
0 �' ` � d 5 .L u
�� ,^ d
f Y V � =s� � �i
Y e .i. � k
� � � , '^,� � r �u
+ -: ,� � �� „ �E
� � . �
� a
�� y � -
� 3 � '� R S� �a
k � � a
� , � � p �
� � � V < `V � W
u � d � n o ul cL w v. �
� � L' �� � p � `J a0 M �
e o p � o a y� M r.
Y � { M �' �+ d r D �n ? 7
a-y �,�, � 3 3 a o v v a-
;. . � ,d • � >
�3 � : o o U �• _� u ,�
r �' � �� � n Z W � � n �
r r '
�• �' � ' � £
J1 ¢ p T � �
i t
� o
Q � SNOW 1 S 'M 'O'�l
'_—�_r--t���
Septic Tank�s)Manufacturer.
IN-GROUND GRAVITY DISPERSAL AREA wieserConcrete
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s)
3-ft Trench (down-sizing credit) �5o gal gal 9a� 9a�
Effluent Filter Manufacturer
Lifetime Filter LLC
I
em�e�c F�ne�Moaei a: LT-1/8
m�� ,z�
Mvi�U
SOIL COVER
�2�
min.trench
iHa n � TYPICAL TRENCH
i�— a'a.,
'.a •. CROSS SECTION VIEW
avc��� , ` , ' (No Scale)
• � • Provide minimum 3 ft
System Elevation = 89•00 � separation between trenches.
(typical)
Quick4 Standard-W
w/end cap ObservatbnPlpe TYPICAL TRENCH
(Show location of inlet/ outlet pipe connection on plan view.) (�vv��0
(typical) Installpermanuracmrers PLAN VIEW
_ _ �_s"°"�°°s (No Scale)
� n ,
i - �� - - - - - - - �� - - - - - - � .,I �A= 3.Oft
— — _ — . . �.• , . � � .,, (hPical) �
� — — _ — — — �� — — _ — — — — �� _ — — — — _ _ J ^
g - 47 ft � m
(ryplcal) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: ��YP���� �
(mfd by Infiltretor Syslems,Inc.) �
Install pursuant to manufacture�s instmctbns. �
�� Quick4 Std-W @ 20 ft� EISA/chamber= 220 ft'
+ � Pairs of end caps @ 6 ft EISA/pair= 6 ft'
= Proposed EISA per trench = 226 ft' Required Infiltration Area= 429 ft' DiStributiOn M2thOd:
x 2 trenches = Proposed Total EISA= 452 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, al� 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 = 300 yPd; BODS<_ 220 mgL-'; TSS <_ 150 mgL-'; FOG <_30 mgL"'
Insaection 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 distributio� 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 (1l3)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: R8y VISOCKy Phone: 715-634-1679
�o�i 9o�emmer,t �r,�c: Sawyer County Zoning & Conservation Pno�e: 715-634-8288
�oca� govemmentunitaddress: 10610 M2in St, Suite 49 ; Hayward, WI 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.
Continpencv 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.
"`"`` PRNATE ONSITE WASTE TREATMENT �ounty
, � �.
�``��$ s ��1, SYSTEMS
�-�, P ,,� Sawyer
�\�� :� ( POWTS)
���—;;-��
�F�s`-'"y''''" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� �3��
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. (5.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�a�,.' d—��� l��a� �e,v,2o 1' r—
Insp BM Elev: BM Description: Parcel Tax No:
I
(6�'� �a�l w � n�o�oa j,�,� gr� �� ,1 __ q`{-' �.Z -(7 - �3��
T�`•�S'L
TANK INFORMATION ELEVATION DATA � ��a ►
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w; `7� Benchmark pa,��
Dosing
Aeration Bldg. Sewer �'j(,Y6 �
Holding St/Ht Inlet �, r
TANK SETBACK INFORMATION St/Ht Outlet �p,? �
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic +S� ,�..a� �(nt .�..�o� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �j,a �
Holding Dist. Pipe
PUMP/SIPHON INFORMATION Surface e $ ;a�
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W 3' L � y � #of Cells Type of System Distribution Media Manufacturer:
p� Conv ❑ Aggregate ��`�
SETBACK P/L Bldg Well OHWM of Nav � IGP Chamber
INFORMATION Waters � AG � EZFIow Model Number:
CELL TO ^- �(- ,� / ❑ Mound o Other
— �--_—�o.� __ � _ -�v -- --- _ _ _ -- - __---- --� --
DISTRIBUTION SYSTEM x Pressure Systems Only
Header/Manifold � Distribution Pipe(s) - - - - X Hole Size X Hole Observation Pipe�
Length Dia Length Dia Spac j 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.)
���� < <(3I��
Plan revision required?�Yes ❑ No 03 �3 �3 __ ' G�,, _ � �cj, �'�7 �� �
Jo
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS AN� SKETCH
SANITAAY PEAMIT NUMBEA:_�� �,�
� S�a�S V`�` •
��
�n���
13�� , � � . ._ - -- � - .
d�` �6�.
� �,��,,
.�, ,
�,�.s
� � ,
. �
;
_ . _._ . _ _ .
o s' ,� : '
�
,
wi� �'
7s� �o-
w��,T
7 � QY.� x l I
� �I� - �� �
-� •
` ��
S�_
, ��