HomeMy WebLinkAbout008-118-12-0001-SAN-2022-316 cow,cy l�/�
_"'�" Department of Safety Sawyer �
. � � = &Professional Services,
�,_ S ; Sanitary Permit Number(to be filled in by Co.
,, , �: , Industry Services Division �
` .�° � 3�'� �q5 ,
Sanitary Permit Application StateTransactionNumber W
�
In accordance with SPS 383.21(2),Wis.Adm Code,submission of this form to[he appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note Application forms for sta[e-owned POWTS are submitted[o Project Address(if different than mailing add
the Department of Safery and Professional Services Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15 04(I)(m),Stau. 3154N County Hwy F
I.Application Information-Please Print All Information
Proper[y Owner's Name Parcel#
Williams Cottages LLC 008 1 1 8 1 20001
Property Owner's Mailing Address Property Location
2316 24th Ave.
Govt.Lot
City,State Zip Code Phone Number
Rice Lake WI 5'�gbg 'h, '/., Section 27
U.Type of Building(check all that apply) Lot# T 38 N R 09 E or W
lor2FamilyDwelling-NumberofBedrooms 3 SubdivisionName
Block# Village of Edgewater
❑Public/Commercial-DescribeUse
12 ❑Cityof
❑State Owned-Describe Use CSM Number ❑V illage of
jd.�own of �gewater
/
IIi.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i
a licable.
A ❑New System Replacement System g y ( p ) ❑ Additional Pretreatment Unit p )
❑ Other Modification to Existin S stem ex lain (ex lain
B' ❑ Holding Tank -Ground ❑ At-Grade ❑ Mound ❑ Individual Site Desi n
g ❑ Other Type(expluin)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Permit Number and Date issued
❑ Transfer to New QHmer
Expiration uh�[, �
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(st) Dfspersal Area Proposed(sf) System F.Icvation
450 7 �}3 653 92.0
Capaciry in Total #of Manufacturer
Gallons Gallons Units � v � �
Tank Information � y
New Tanks Exis[ing Tanks � c c� � � � �
o �; � `�
a U v, y v: cs. C7 0.
Septic or Holding Tank 1000 1000 ] Wieser }t
Dosing Chamber
V.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signa re P/MPRS Number Busmess Phone Number
Rick Brown - � 231251 715-419-0739
Plumber's Address(Street,Ciry,State,Zip Code)
PO Box 637 Spooner WI 54868
VI.Coun /Department Use Only
� � Permit Fee Date Issued Issuing Agent Signature
Ap ro ❑Disapproved j�.�� � �
��w ❑Owner Given Reason for Denial $ `��•� � G � 3 ( I '� � ' I�! IL+i(/�-�`7'
Conditions of Approval/Reasons for Disapproval
�ate 1� 3I a � nl� �� � ����3�.
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IN
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chk# `��s 3 _ OCT Z 4 2022
_
cs�-�a _ ���� 4.f:-��e��_.f��� ���r,� _� 3���� ��ER Co��n
Attach to complete plans for the system and submit to the County only on paper no[less than 8 ui x 11 inches i s e � � ,.,,� � �G�
SBD-6398(R.03/22)
NO REFJ(�DS AFTEi9
ISSUC OF PE�iMiT
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
Williams Cottages
Owner Name(s): W�Iliams Cottages Phone: - -
Owner Address: 2316 24th Ave. Rice Lake WI Z�p; 54868
Project Address: 3154N County Hwy F Birchwood WI 54817
Govt. Lot: 1 /4 of 1 /4, Section 27 , T 38 N-R 9 E ❑ or W ❑✓
Township: Edgewater County: Sawyer
Project Parcel ID #: 008118120001
Designer Information
Designer Name: Rick Brown Phone: 715 _ 419 _ 0739
Designer Address: PO Box 637 Spooner WI Z�p; 54801
E-mail: rickbrown2004@hotmail .com �ri,;, sr,�,�� ,��,en��� ro,� �,�,E„ �,��,, �r�,;;,�,
License Number: 231251
Remarks:
Si nature: � 4 Date: 10/1 /22
� Original signature required on each submitted copy.
CHECKBOXASAPPLICPBLE CHECK ASAPPLICPBLE.
❑ SOIL EVALUATION o sca�e:4°o ao' � 80 SYSTEM PAGE 2 OF 4
SITE MAP PLOT PLAN
PROJECT NAME: oesicN F�oW: 450 �Pp
(loftgrltl) 10'
Williams Cottages Attach design flow calwlations for commercial plans.
PftOJECT AD�RESS: S'I S4N COUfISY HVJy F BIfCIIWOOfJ � Pipe Material/ASTM Standard(TaWes 384.30-3&36430-5)
Nsa�narys�we� 4 r
BM SymDol:� BM Elevatlon: 100 F7 Force Maln: !
BM Descrlplbn: TOP O(W811
mm�aie�nn� IMPORTANT:
Slope Gradlem(°h) � Well Symbd(if appllwDle�: Q tlrawing an ShOW ground eleVatlon Con�oufs at 5uitable Intervals.
of TeSIeE Area: on Ihe approprlle 1�.
L
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Septic Tank(s)Manufacturec
IN-GROUND GRAVITY DISPERSAL AREA Wieser
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s):
3-ft Trench (down-sizing credit) �oo0 9a, gal gal gal
Effluent Filter Manufacturer:
1
Polulock
I
em�e�c F�ice�nnoaei a: PL-525
min.12"
SOIL COVER (Hp��l)
12^
min.trench
tlepih
roa��n • TYPICAL TRENCH
a CROSS SECTION VIEW
f`�hP�� (No Scale)
� , •� ' • Provide minimum 3 ft
System Elevation = 92.0 g separation belween trenches.
(typical)
Quick4 Standard-W
w/endCap O�servatbnPlpe TypICALTRENCH
(typicaq (Show location of inlet/outlet pipe connection on plan view.) (bv��a0
InstallpermanNac[urets PLAN VIEW
Inshuclions. /N� SCa�e�
— _ — — � \
� •!• l�tZ� — — — — �� — — — — — — — �� — 11tt������llt��117�t• �
��u��ulC' - - - �� _ �� _ �uu�� a � . � A= 3.Oft
� - o� � � I�ui��Y��u�Y� (NDiwi) �
- - - - - - - - - - - - - - - - - - - y
� B = 75 ft �� m
(rypical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typicaq Q
(mfd by Infil�rator Systems,Inc.) T
Ins�al pursuant to manufacturer's insimctions. �
16 Quick4 Std-W @ 20 fP EISNchamber= 320 ft'
+ Z Pairs of end caps @ 6 ft'EISA/pair= 6•0 ft'
= Proposed EISA per trench= 326 ft� Required Infiltration Area= 643 ry� 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 382384,Wisa 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 Operetinq 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 specifcation)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tank(s1 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(sl shall be inspected every 3 years and shall be Geaned 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. RepoR any component failure ar malfunction to:
Name of individual or company: Ke� WaY Phone: 715-234-7677
�ocal government unit: SBWye� CoUnty ZOfllllg Phone: 715-634-8288
�oca� government unit address: 10610 Main St. Room# 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.
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.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
„,��'='"'`"E^r.,y PRIVATE ONSITE WASTE TREATMENT County
1�j� o'$P 1�'i SYSTEMS Sawyer
� � $' K;
�:4'� 1.�; ( POWTS)
\�N����i:/
�Fs�'"���=�' INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �a � 3 ��
Personal infonnation you provide may be used for secondary purposes[P�ivacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village ❑ Town of: State Plan Transaction ID#:
�II��� C� c.�� ^
Insp BM Elev: BM escription: Parcel Tax No:
(O0.c'�' � �.' cro�3- I l g-c 2-6 0o I
TANK INFORMATI N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic „J�� ��� Benchmark �p� '
Dosing
Aeration Bldg. Sewer 9�6 r
Holding St/Ht Inlet !7•9.5”�
TANK SETBACK INFORMATION St/Ht Outlet 9 7.6 S�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �—�D � fi--�...5� fi�.�� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. (Y,/ `
Holding Dist. Pipe
PUMP/SIPHON INFORMATION Infiltrative
Surface R3.( �
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORM TION
DIMENSIONS W 3t L (�y� 6 #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate 1K < <
INFORMATION P/L Bldg Well Waters � IGP � Chamber
❑ AG o EZFIow Model Number:
CELLTO ❑ Mound o Other �Y�
- --__ — - -- --- —
_-- -- ----- — ---
DISTRIBUTION SYSTEM X Pressure Systems Only
- — — ----- - -
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia �ength Dia Spac �_ Spacing ❑Yes ❑ No �
_ -- — ----- —
SOIL COVER
- _—_
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoil � ❑Yes ❑ No ❑Yes ❑ N�
-- -- —
COMMENTS: (Include code discrepancies, persons present, etc.)
�'��J�/�'`'/
- — —
—__—_ _
Plan revision required7�Yes 0 No � � � �
3 3 -Z - __ ---- ----� 6� J�1 -� �
Use o t her si de for a dditional information Date POWTS Inspector's Signat e— Certification Number
SBD-6710(R.3/01)
AD�ITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA: ��.�--.3�
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