HomeMy WebLinkAbout002-840-06-5106-SAN-2022-317 ��` Department of Safety c°""�' (�
-�\`� f - & Professional Services, S"�Y�� �
_ � _ = Sanitary Pemtit Number(to be filled in b�
� �, �'_ . Industry Services Division � �
_ (9 3�'� ��I � �,
Sanita Permit A 11(�,at10n State Transaction Number �
rY PP U,
1n accordance with SPS 383.21(2�Wis.Adm.Code,submission ofthis form to the appropriate governmental unit —
is required prior to obiaining a sanitary permit.Note:Application forms for state-owned POWT'S aze submitted to Project Address(if different than mailing J
the Department of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Pri�acy Law,s. 15A4(1 xm),Stats. �����/� ������t I i
I.Applicallon Information-Ptease Print All Information �� C ��
Property Owner's Name Pazcei#
-- J��T�h �'1c�c(S��'` (7uZ-�`��'-t'i�- ��0�
Property Ow�er's Mailing Address S( � L ddn 'V d�. � Property�cation
1 �
r���
- Gov[.Lot
City,State .���` �,, Zip Code 3� Phone Number Q�
-_ , �__ �"'�—�° Section
II.Type of Building(check all that$pply) �t# T �� N R �� E or
or 2 Family Dwelling-Number of Bedrooms � � Subdivision Name
�—
Block#
❑Public/Commercial-Describe Use
� ❑City of
❑State Owned-Describe Use CSM Number ❑Village of
�� ��q �6qz—t �o�,of �..s s ��
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicabie on line A. Check one boa on line B.Compiete line C if
a licable.
A' New S stem ❑ Re lacemeirt S stem
y p y ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Hoiding Tank -Ground ❑ At-Grade gn yp ( p )
❑ Mound ❑ Individual Site Desi ❑Other T e ex lain
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner
ist Previous Permit Number and Date Issued
Expiration r--
IV.Dispersal/Trcadnent Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal,�rea Required(s� Dispeisal Area Proposed(s� System Elevation
ysp � � � �� 9z.r� qs-
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o � o
New Tanks Existing Tanks � o Y � � � � �
c� U v� � v� w C7 G,
Septic or Holding Tank �O�
Dosing Chamber j`` ��fi.� j 1�� �Sy�
,r .,V
V.Responsibility Statement-I,the under�gned,assmne responsibility for installalion of the POWTS shown on the attached plans.
Plumber's Name(Prmt) Plumber's Signature MP/MPRS Number Business Phone Number
Q � �� S���C�"Z )Sl,��Z y ?�s`-S�ss' . g4,�,y
Plumber's ddress(Street�City,State,Zip Code)
`7���6� . S�n� ��� . ('d S`(,Y�7
VI.C n Department Use Only
� � Permit Fee Date Issued Issuing Agent Signature
Ap ro � ❑Disapproved $ �^•�p
❑Owner Given Reason for Denial f � ���� I 3� i �� '����'�"�L��-
Conditions of Approval/Reasons for Disapproval
�� ' ��i�� iv 3 i �a � ,
. .._ --t'�s;'?c��.�t r
��.h'3 `,��'r � ���' � � !
� _ --• _� ���� �� � `
C S) �-�-- ��� �1.,�.��, c,`J�r t d �3`�9 0 ' ,,��p�' ` '_.----- ,i;; '
� '�
.�,M .� ��� � � �nLZ F�
.. � C . --i 1.��S.r �
Attach w com lete lans for the s tem and submit to the Cou y p pe ���p--�"-;-,-. , I r,�� �
p p ys �rty onl on a r not less than 8 ll z-11 x�e
NO REFUNDS AFTER - : „ , ,;;.; � ;,i�v�i 11J�V
SBD-6398(R.03/22) ISSUC OF PEF�MIT ` .
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): �� Phone: - -
59207 423r�+ o��� �����^^^ ^"N 55956
Owner Address: � �� Zip:
Project Address������
Govt. Lot: 1/4 of 1/4, Section 06 T 40 N-R �$ E ❑or W Q
Township: Bass Lake County: Sawyer
Project Parcel ID #: 002-840-06-5106
Designer Information
Designer Name: Dylan schultz Phone: 715 _ 558 _ 5904
Designer Address: 16880W Metcalf RD Z�p: 54876
E-►T181�: C�y�8f1SC�lU�tZ� B�gfT1dI�.001'Tl '�i�is space reserced ic>r aPj�roval .�a up.
License Number: 1516129
Remarks:
Signature: Date: � ° 'Z`�'Z�
i al signature required on each s mitted copy.
�`^1"� • � /,C(+ -�-. 1'�L.J�"""
' V "�
o���r : L�:
�r�—�D• ' �: �l �. �C'�-4.�/2�-- S�4wy2�- � � �4sS l.��Q T�J�
1
S� Z o� t-f� 2-3 �"� A�v� -�� ►�1 : Do z -- ��t b— 06 — S ! D(p
Vn�.z.p �� , M � ss���e � D6 T' �to � fZ o8w
5:��'- �`f[3 ►J S.ecl��e� Z�r' � Lo-�- � C-S t�-1 Z--lo�Zz1'i � 6S Z?
�
qyl3
s�.(� l = `�o�
p
Vr.. �y Lo 2a 3a Yp
�` r �
I000/bpp �
Za + �ro � -�-,
�
' • oo - 3 !�d I► �►�t �oo � � , -b6o� '�`
na. r�
w/ Wa�k°�� �e E�s-� S�de lD" SPrv��
i2oP�'"�, � r. ��.�f `
• � � _ �p �a -
°� Z. Q� .3
Bh c� ' 3 _ �t L.�t `
r / .�t Sa; � s� s�� eL. 94 �
3� sk��� .
Crahge �t2S" —�5 �
4 �`-� L�-
7s � �r����S P��.� - ��)
�
3`f { �
— � Q�e �. Ftoo �- LeJ21 t �3 �
` � — Wcc�kov�" 'F�bo.r c�. G�A��
�,o
�i �
�� — �s-� 6l� Sewe.r G2,�` k
� ' � Jv. —� ST ��1 �tZ `
c / ,�r � � �T (�l « 88 .S �
xa � � Lpc���nn � Sl2c U'� YlDkt� c�L �tv2�
� ��.J�l( �o w�eef Ct� b� s��ks
��,-
�
Dylan Schuftz �
� 7076N Stone Lake Rd
� Stone Lake, WI 54876
MPRS 1516129
,
Z S�� �76
� `
� �t
Z
�
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
m��tr TyPICAL TRENCH
SOIL COVER (Npl�l�
CROSS SECTION VIEW
'Z� (No Scale)
min.Nench
depN
(�YPlcaq . •
' . ..e .
��.••. .
�ry��`a�� „ ,'. '' Provide minimum 3 ft
. • separation belween trenches.
System Elevation= ft
(typical)
Quick4 Standard-W
w/End Cap Obsenatbn Plpe
(typical) (Show location of inlet I outlet pipe connection on plan view.) Install pe�amAacturers n'PICAL TRENCH
��«�u�,s. PLAN VIEW
r ___ L (No Scale)
RR�RIIE)PR�����._ ___J�_______J/ '�TRlBAR �
/ /
� u .,. . d;:,. , A=3.0ft
L———�tttYl��'�f��`_ __ totit�7& J (tyPlcal)
---��-------�f--- ----- �
B= � ft —�-i �
�ryP���� Quick4 Standard-W Chamber m
INSTALL PERTRENCH: �ryP���� �'`�
� (mk by InflltretorSyatema.IncJ O
r Insfall pursuent to menufacWrere Instrudbns.
Quick4 Std-W @ 20 fF EISAlchamber= f 10 b ft' T
+ � Pairs of end caps�6 ft'EISAlpair= � ft' /� �
=Proposed EISA per trench= I66 ft' Required Infiltration Area= �P�� ft' Distribution Method:
x �trenches =Proposed Total EISA= ��ft' �"'"`�'/
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4'0 Venl Pipe
>10 fl from
Building Elec�nmlmuslmmplywith
12Min.or2.Oftabove SPS316endNEC300
Eslebl'shed Flood Elevalion Wealheryroof 6dend manhole nser as nece.ssary.
��'p��) Juncfian Box
APP��� Appmved LOGcing Manhole
IMPORTANT: VQ°��P wilh Waming Label Atlached
(�Yoica�)
Mchor tank(s)as necessary Conduil
pursuant to SPS 383.43(Sxg) 4'Min.or 2.0 R above
Eslablished Flood Elevafion
(typi�sl)
�Aiitignl Seal
Finislred Grade
Quick Disconned
� 1B'Min.
CAPACITIES @ /��gaUn `% � . y.:� ' � � ' �ryP'�'>
Depth(in) Volume(gal)
� ` 1
A I J �/• � " *� Wcep Appraved Jainls wiN
S� ; Hole Approved Pipe 3 ft onlo
B '2.0 3 q ' Solitl Gmund
I (typirdl)
�C� R �.�2 �
` Alarm
� �Z 2 ��. �� TB� 'O_On
E� I [C] PUMP-OFF
*Pump Tank Liquid Level = 3 / in —}— PumP �—Of ELEVATION = �9� ft
�
° �„�,�� INSIDE BOTTOM (7
Force Main Diameter = � in a�� ELEVATION = b�' � ft
�
� . . - �
Fo�CC Main Length =�R ( 3'Apprwed Bedding Malenal BeneaN Tank
_I� x � , `
� 163 � 6. �� + `�a.a �.2 x d�5:�.,--�IS��
Force Main Void Volume = b,�� gal
[C] Total Dose Volume DV = � jo. � gal/dose
(<02X design flow+torce main void volume)
Vertical Lift= 10 � � ft
PUMP TANK: SEPTIC TANK(S):
Volume = �� gal Total Volume = ��� J gai
� �
Manufacturer. 1�✓�ySa� Manufacturer(s): (^'����
Pump Manufacturer. �" ��
Install approved effluent filter at the septic tank outlet
Pump Model: =� �$b ��a��P�mP��> immediately u�stream of the�umo tank inlet.
Controis/AlarmManufacturer. SS� FilterManufacturer. N�'�ylc� �
Controls/Alarm Model: Filter Model: ,�Z �
Fioat switches containing mercury are orohibited.
.aoam os..e
Liberty Pumps 280 PUMP 280 - 1/2 HP Cast Iron Submersible Sump/Effluent Pump Non-Automatic 10�26/22, 7:41 AM
��Y �1,.,�e�� �`�yifE�� $�;�y �"i�i�r'�i ��'t:L ��]8��i�1� {3i3 't�i.a`t.��� i'e i��a�i:�a���a�� Y`3`�c' ��'a�ii}3�.::�'s� +.;ia s' ;,af':��r:� �
�2Y'?"#r#S , 4_^ �apra,-e�'p�[�, tnthc.�-. � �rr�h,wc � ^I T(--y-,{h.:,r ��`C�r��iCa:4°���t
Cancel
„ _ �.
Media Gallery X
Liberty Pumps 280 - 1 /2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
Automatic)
�:�
�
Performance Curve: 280-Series
40 r---�--- ,-...r_ _....... _.,._.�..._ _..__�.--�_T__..�__-.__�-_.._ . _ ,._ _ .., , .
, _., _ _.� ., - -
r� , � ; , � � .
�
; ,
; � � ! s i
35 --�-__�.__ _ .
! �
; ! ` i i
,
—+-- +-- -
I i j
t ;
30 - - - ; . �,
f
.-•. .
♦� k
cU 25 ' '
.
, `
4) � _
u� 24 � � �
3 �
,� , Po�.m�Ke��....:�
., , �.�.
c� 15 3 ; _�
� � � , , `��
__,
� f ,�
� ;
� o . , � ,
� �
� ' , ;
5 , � ; '
,
, i � �
' . � ;
� E I � � ; �
�__�1.__.�..._..L � _ � � r _�__i_�.._� _.. a.�..._ .1..�_'._�__.s_...-.S�.i., ._..i_'.r_ t'
0 5 10 15 20 25 34 35 4A 45 50 55 fi0 65 70
U.S. Gallons Per f�linute
��
� �
05� � �
2012
� 26
C
� �o�����o+r
sP��M`N,��F�
N�NG PG
https:/(www.sumppumpsdirect.com/Liberty-Pumps-280-PUMP-Effluent-Pump/p8575.html Z� Page 1 of 9
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Oaeratinq Limits:
Design Flow = 7 Sv gpd; 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 mechanicai malfunction (i.e., pumps, vaives, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatmerrt tank(s) and any distribution appurtenance(s) (i.e., distribu[ion /drop boxes)
o negiect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extem of ponding in distribution cell prior to dosing
o dosing irregularfties- 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 oritice 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 (7/3)the liquid volume of the tank(s)or
as required by local ordinance. Disposai of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s)shall be inspected every 3 years and shall be cieaned when necessary to remove any
accumulated solids according to manufacturer's spec'rfications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accoMance with
SPS 383.55 Wisc. Admin. Code. Report any compo�ent failure or malfunction to:
Name ot individual or com an � �`� S��� I� � Phone: �I S ' � �'`�� S��U�
P Y —
�ocal govemment unit: C � Phone: 7�5 6 3 � - �� �g
1
Local government unit address: ���G M`"� s ��{e� / I��y�"" � Z�p ��y �
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 tailed or maifunctioning components shaii comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used uniess approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Continqencv Plan
In the event that any failed treatment component of this POWfS cannot be repaired, it shall be repiaced 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 ot this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
Reset Page
' `'""E` PRIVATE ONSITE WASTE TREATMENT County
;��?�o$P, .��1';�'� SYSTEMS
`������/��? ( POWTS) Sawyer
\�%DUF✓�=/
�rs=-�'="-=� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division
(ATTACH TO PERMIT)
GENERAL INFORMATION �a _ 3 � 7'
Pe�onal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(()(m)J
Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#:
N�a h Ati.�.rs J�, (�usS l.�I�-�
Insp BM Elev: BM Description: Parcel Tax No:
���,� ��� � � c�e.� ��,� �n�o�ow � S a' Oc�2 -�Yo -06—SI o�
TAN INFORMATIO .,,.sZ ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ,�,;¢�_ _ �ma Benchmark �p.a �
Dosing --w,r,L,o 6oa
Aeration Bidg. Sewer �t y.$$ �
Holding St/Ht Inlet 9Y•�f �
TANK SETBACK INFORMATION St/Ht Outlet sy,� �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic f2�� +-Sp 7 ` +� ' NA Dt Bottom `�0.q �
Dosing " �• « °� NA Installation
Contour
Aeration NA Header/Man. �j� S- r
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �3 � i
Surface
Manufacturer [�, Demand Final Grade
Model Number 3$7 GPM k`��' V"T• ���3 �
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L �/S Dia 2 " Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W ` � 32' 3?' 3Z` 31 � #of Celis Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ���
INFORMATION P I L Bldg Well Waters � AG � Chamber Model Number:
❑ EZFIow
CELLTO �-S .{-�D� �V--� .►-7j ❑ Mound o Other Qy�
-- --- _ ___ _- -- ----- --—
DISTRIBUTION SYSTEM ' X Pressure Systems Only
Header I Manifold Distribution Pipe(s} X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac Spacing ❑Yes ❑ No
---- — - - --- __- -- — ---�— — - —�
SOIL COVER
--
Depth Over Depth Over i Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoit _ i ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies,persons present, etc.)
��,�ll� s�s��3
Plan revision required?❑Yes ❑ No �
o� 06 �� � ��._�,.� __� �� � r�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIDNAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBER: �-31�j
-' ����� 4��
�
�i 73- '
y
�� �� � �
g ���� � L
�` �' g 0'�"�
�-- - - -
� „�,� , -�•
,
}�o i � �
� : _ ___ , ,
• oi _ ,
. : �
;
fP . , . .
, . . __ __ .
r 3 w;,�'� . � ,
� � ����r �`�8�
Y � "V' �
3 $� � °
g� ���` `���
�,�5
�
�1`yP�
�c
�`��i3 �
1d1 � �ec.l����"``�
5 AtE 1"=