HomeMy WebLinkAbout010-941-33-1405-SAN-2022-327 _ ��`""""�� Department of 5afety c°°"�`' `n
- � ,��;-, & Professional Services, s�`�'�' e� �
_ � ; i, Sanitary Permit Number(to be filled in by� Z
�,J, �: ;' Industry Services Division �
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Sanitary Permit Application State Transact^ion Num ber �
In accordance with SPS 38321(2),Wis.Adm.Code,submfssion of this 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� J
the Department of Satety and Professional Services.Personal information you provide may be used for secondary � `
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. y�C�G�3�N R�*�«- s�q�1�'^,`�
I.Application Information-Please Print All Information �ffi
Property Owners Name Parcel#
G�,�',5�',r�e 'r�r 1C C�� U - 9'-I I - 3 3 1 y U S
Vroperty Owner's Mailing Address Property Location
1�1y � 5 �o.�-e 11w 71' co�t.Lo�
C:iry,State Zip Code Phone Number
�G wa�-cl � W= S�aY 3 SP ��,, NE _��,, Section 33
1L 7'ype of Building(check all that apply) �-ot� 7' �'// N R �'ar
�lor2FamilyDweliing-NumberofBedrooms � SubdivisionName
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑V illage of
�'ownof �'1aywQr�_
IIL Type of POWTS Permit:(Check either"New"or"Replacement"and othcr applicable on line A. Check one box on line B.Complete line C i
a licable.)
A. �y^
❑ New System �ceplaeement System ❑ (hher Modificat�on to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank �In-Ground ❑ At-Grade
❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C. ❑ Renewal Refore ❑ Revision ❑Chanee of Plumber �is[Previous Permit Number and Date Issued
❑'('ransfer to New Owner
Expiration �-�Q� (� �Cl� $s DQ� 6rs�
tV.DixpersaUTreatment Area and Tank Informa6on: a, : K p � w► /fnf aF e.^re!
Design Flow(epd) Design Soil Application Rate(gpd/st) Dispersal Area Reyuired(st) Dispersal Area Proposcd(stl System Flevation
300 0 ."7 `�a9 yy � � qS.Sc� � �
Capacity in Total #of ManufacWrer
::
Tank[nformation Gallons Gallons Units � U v ,'�, �
New Tanks Existing Tanks 4 o a� L y D � �
a U v, � rn i�. C7 R.
Septic or Holding Tank Q OO $QO � e K�W ��� L
CJ J 7
�g Chamb'r � ' C' �q tw p �- N �1 �A.��C E�'�CM C 11C� �
V.Responsibility Statemcnt- [,t6e undersigned,assume responsibility for iastallation of t6e POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
\d A nec els Sr ��.c. L 2 0 7/5-.5�8-(0�/7
Plumbers Address(Street,City,State,Zip Code)
ga�sn� s+,�� Ro�a a� 1-I�. Wa�d, l.�,s .5*�►�y3
VI.Cou ty/Department Use Only
� ll Permit Fee Date Issu�d lssuing Agent Signatur•
Ap r e ❑Disapproved $ -
�,.,, �{pa � � � �� �� -��.��.c-� ��
❑Owner Given Rcason for Denial �
Conditions of Approval/Reasons for Disapproval ' { r-,� � �'�' 1
,
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�oNw�p�nr���!����-,ar�c;n�.
Attach to complete plans for the system and submit ro the County only on paper no[less than 8 U2 x I l inches in size i.� � �.�
SBD-6398(R.03/22) N�J R�FJNDS AFTER
ISSU�OF PEFi1MT
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) C�a -�7 �
2• `
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
Stark - Ranger Station Rd
Owner Name(s): Christine Stark Phone: - -
Owner Address: 14415W State Hwy 77; Hayward, WI Zip: 54843
Project Address: 9931 N Ranger Station Rd
Govt. Lot: SE 1/4 of NE 1/4, Section 33 , T 41 N-R �9 E❑or W ✓0
Township: Hayward County: Sawyer
Project Parcel ID#: 010-941-33 1405
Designer Information
Designer Name: Ronald A Spreckels Jr Phone: 715 _558 _6472
Designer Address: 9205N State Road 27; Hayward, WI Zip: 54843
E-mail: ronspreckels@yahoo.com , ,��,�,;� �;i f� , , , , _„
�
License Number: 226688
Remarks:
Signature: �i� Date: !% / o � /a�
Original signa ure uired on each submitted copy.
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Septic Tank(s) Manufacturec
IN-GROUND GRAVITY DISPERSAL AREA Skaw (olus Wieser Filter Cannister)
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s).
3-ft Trench (down-sizing credit) aoo 9a, 9a, gal gal
Effluent Filter Manufacturer.
�
Lifetime Filter LLC
i
Em�e�� F�ice�rnoaei a: LT-1/8
m��, ,r
caai�q
SOIL COVER
,2
min.trench
tlepth
�noi�eu • TYPICAL TRENCH
— -- a �, CROSS SECTION VIEW
r�--- 3q.. . .
�cYP,�� � (No Scale)
� • Provide minimum 3 ft
System Elevation = 95.50 ft separation between trenches.
(typical)
Quick4 Standard-W
w/endCap ObservalbnPlpe TYPICALTRENCH
(rypicaq (Show location of inlet 1 outlet pipe connection on plan view.) �nstall perYmanufacNrers
PLAN VIEW
�°s"�°"°°s (No Scale)
� - - - - - - - - - - �f- - - - - - - - �f- - - - - - - - - - - , �
A = 3.Oft
- . . . � MPiwq �
� - - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - J �
� B = 91 ft -� m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typicaq �
(mfd by Infiltrator Systems, Inc.) �
Insfall pursuant to manufacWrefs instmctions. �
22 Quick4 Std-W @ 20 fl� EISNchamber = 440 ft=
+ � Pairs of end caps @ 6 ft EISNpair = 6 ft'
= Proposed EISA per trench = 446 g� Required Infiltration Area = 429 ft` Distribution Method:
x � trenches = Proposed Total EISA = 446 ft�
�
� 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),Wisa 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 Disqersal Area Operatinq Limits:
Design Flow= 300 9Pd; 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 a�aerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution !drop boxes)
o neglect or improper use (i.e., exceeding design rapacities, 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 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 W s.
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(s)shall be inspected every 3 years and shall be Geaned when necessary to remove any
accumulated solids according to manufacturers specifications. A servicing period will always be greater than 1�:
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: R011ald A SPfeCkels Jf Phone: 715-558-6472
�o�ai 9o�e��me�t„�;t: Sawyer County Zoning & Conservation Phone: 715-634-8288
�oca� government unit address: 10610 Maln 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.
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.
/''�'�'��"'�^�c;� PRIVATE ONSITE WASTE TREATMENT co�nty
i��� ��':�;�.
;� , o$ �,y; SYSTEMS Sawyer
`��1��Ps /�� ( POWTS)
��;F�_�;;;%
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� �3�7
Personal infonnation you provide may be used for secondary purposes[Pdvacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
��;5��.�-afk a wa� '—
insp BM Elev: BM Description: Parcel Tax No:
!
(�o.o n� v�,�� �l�.-`�Y(_33 —(�(�5�
TANK INFORMATIO ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � � 5K � �oa Benchmark (pp,o l
Dosing
Aeration Bldg. Sewer
Holtling St/Ht�nlet —
TANK SETBACK INFORMATION St/Ht outlet �6 g 7 r
TANK TO P/L WELL BLDG A�Rr',NT°KE ROAD �+e�, �;� SN 6 ,� '
Septic NA � � p� �,(,,$ �
Dosing NA Installation
Contour
Aeration NA Header/Man. �
.
Holding Dist. Pipe
PUMP/SIPHON INFORMATION Infiltrative
Surface 4S b �
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W L �$ #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nau � Conv ❑ Aggregate '����
P/L Bldg Well ❑ IGP � Chamber "t��
INFORMATION Waters ❑ EZFIow Model Number:
❑ AG
CELL TO *2� �}-,�S` �� h1 ❑ Mound o Other Qy�..
_------ _ - --__-----
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
- -- ---— - --- -__-- --
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.)
��,.s�l i i�rs/�a
� N e„'' �.� d` c�(�s ex�� S.T.
- - ---
Plan revision required?❑ Yes❑ No p 3 (3 _� �_ � � /�'� �
�� v � �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITI�NAL COMMENTS AND SKETCH
SANITAAY PERMIT NUMBER: aZ� -- 302`7
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