HomeMy WebLinkAbout014-941-03-5105-SAN-2022-329 _- u' Department of Safety c°°°�' SAWYER �
� = & Professional Services, �
� =r = Sanitary Permit Number(to be filled in by�
_ � Industry Services Division �
�-,,;:,... , (9 3�I 308 R,
State Transaction Number (!�
Sanitary Permit Application NA �
In accordance with SPS 383?1(2),Wis.Adm Code,submission ofthis fortn to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-0waed POWTS are submitted to Project Address(if different than mailing a�,�cs,�
the Department of Safety and Professional Services.Personal informadon you pmvide may be used for sewndary
pucposes in acwrdance with ihe Privacy Law,s. 15.04(1)(m),s��. (same)
I.Applicallon Information-Please Print Ail Information
Property Owner's Namc Parcel#
STEPHEN B. & MAJORIE B. MOLSTAD 014 9410 35 105
PropeRy Owner's Mailing Address Property Location
1 l 752N C.T.H. T Go,�.Lot 1
City,State "Lip Code Phone Number
HAYWARD, WI 54843 715-634-3]30 �4, ��,, se�non 03
II.Type of Building(check all that apply) Lot# T 41 N R 09 Eldr W
C�or 2 Family Dwelling-Number of Bedrewms _� '-t� 4A & 4B Subdivision Name
B�ock# NA
❑Public/Commercial-Describe Use NA
❑City of
❑State Owmed-Describe Use CSM Number#1753 V A;P323 ❑Village of
#1821; V 8, P448 ���f LENROOT
III.Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A.
❑ New System �Keplacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(exp(ain)
B� ❑ Holding Tank ❑ In-Ground ❑ At-Grade gn � yp ( p )
❑ Mound ❑ Individual Site Desi Other T e ex lain
��°°���°�'� eo mat
C- ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner �st Previous Permit Number and Date Issued
FX�����on 57431 / 09-18-84 �y- 13Y
IV.DispersaUTreatment Area and Tank Tnformation:
Design�SO(gpd) Design Soil�pplic ion Rate( /s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
`� � 0.(o o.a 225 227.50 89.00 FT.
Capacity in Totai #of Manufacturer
Tank Information Gallons Gallons Units �, � o � �
New Tanks Existing Tanks � o � � � � @ �
n U vi h in w C7 %s,
Septic or Holding Tank 1��� 1��0 1 RASMLJSSEN A
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installaGon of the POWTS showo on the attached plans.
Plumber's Name(Print) Plu r' ignature MP/MPRS Number Business Phone Number
�l- �1 � ( �/', � �� ��(� // �c��S���` ��
Plumber's Address( et,City,Sta[e,Zip Code)
.�
I!�j`� i � � " l'� =� �`�f� ,({.d���� � "�' i' '�T �� �
VI.Coun /Department Use Only
�l Pertnit Fee llate Issued lssuing Agent Signature
� 0 Disapproved
� ���ti✓ ❑Owner Given Reason for Denial $��`�'�� �� � ��� � �`� ��'�-�����'--f i"t/l/7.��-
Conditions of Approval/Reasons r Disapproval r..m-.1.���;r' <"� � ,{-,�
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ZONi�iG p,D�AINI�T
Attach to complete plans for t6e system and submit to the County only on paper not less than 8 t/2 x 11 inches in size � --� S-_�3
NO REFUNDS AFTER
SBD-6398(R.03/22) ISSUC OF AERMiT
7
<< � �,
G�oMst IN GRaUND AND DOStNG DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
Owner info
Projed Name: STEPHEN B.8 MARJORIE B.MOLSTAD
Owners Name: (SAME)
Owners Address: 11752N COUNTY HWY.T
HAYWARD,WI 54843
Prop@rl�l h�f0
Property Address: 11752N COUNTY HWY.T
Legal Description: _ S_ 3 T 41 N R 9 W
Township Lenroot Counly: Sawyer
Subdivision Name: NA
Lot Number: 4,4A&46 Block Number: NA CSM#: 1753 8
Parcel I.D.Number. 014941035105 1821
Plan Transactan No.:
Index Pages
Page 1 Index and title Page 9 Filter specrfications
Page 2 Data entry ` y>� '`� Soil test
Page 3 GeoMat dist.cell drawings&calculatans �a'�
Page 4 Lateral and cell cross section {"' "'
Page 5 Management&contingency f a��.• '; Aenal
Page 6 Maintenance&specfications =��.� �,t su,.�a�-K (z �•�
Page 7 Distributan media p^Y` ��r ^� `°'t'" '�T
Page 8 Plot plan �16 p-rs�'��r'��
MARY JO HUPPERT License Number. 1859-007
Date: 10/15/22 Phone Number 715�26-1775
Signature: � ����� _ r " C C�
Desgner Sfamp: -
.��`' •
:� , ' � -
�.� :' i.:.�� . • ..aesigneC Pusuarq to the
_ ' GeoMat In Ground Componerrt Manual Ver.June 26.2018 Version�,Ll,l� 7L'z z)
:i •..
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,�,- ``�+;. Page 1 of 73
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In Ground and Dosing Distribution Component Design
Design Worksheet
Site Information
R� Residential or Commercial Design N ISD Required?
300.00' Estimated Wastewater Flow (gpd)
1.50 Peaking Factor(e.g. 1.5 = 150%)
450.00 Design Flow(gpd)
15•QOi Site Slope (%)
89.00 Prop. System Elevation (ft)
70.00 Depth to Limiting Factor(in)
0.� In-situ Soil Application Rate (gpolftZ)
91.66 Lowest Original Grade Ele. In System Area (ft)
93.461 Highest Original Grade Ele. In System Area(ft)
85.86 Limiting Fador Elevation (ft)
2.96 Depth Below Grade
Distribution Cell Infortnation
— 325 Cell Width (ft) �1 Number of Cells
2.00! Dispersal Cell Design Loading Rate (gpd/ftZ)
2 �nfluent Wastewater Quality(1 or 2)
Distribution Information
E Center or End Manifold, Dist. Box or Drop Box
� Number of Laterals System dosed� N I
0.00 Lateral Spacing(ft)
System not dosed
Man cturer Infortnation
Treatment Tank Information Effluent Filter Informati n
1000.00 Septic Tank Capaci gal) Orenco Systems �O Filter Manufacturer
Andry Rasmussen&Sons, Inc. Manufacturer ��,�""�.,�o, Filter Model Number
Project: STEPHEN B. & MARJORIE B. MOLSTAD Page 2 of 13
In Ground Plan View
1 � c��IlIl c����I��
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.� O�O�O�O�O O�O�O�O�O�O�O�O�O�O�OVO�O�O�O�O�G�O��m � Qe� �O�O O�O��O�O�O�O�O �
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Calculations
I s ;,ft A 325 ft Basal Area Required 750 �
K 1 ft B 70 ft Basai Area Pro osed 752.5 ftz
S 0.00 ft L 72 ft
W 10.75 ft
Basal Area Calculation GeoMat Dis ersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
450 0.6 gaVsq fUday 450 2.00 gaVsq tuday
Total 750 ftZ Totai 225 ft
Pro osed 227.5 flz
Number of Cells 1 GeoMat Width 3.25 ft
Cell Length 70.00 ft Lineal Feet of GeoMat Required 69.2
Min. Cell Len th 69.2 ft Lineal Feet of GeoMat Proposed 70
Cell Spacin 0.00 ft N07E:Min S dimension= 1'
S stem Elevation 89 ft �
Limitin Factor 85.86 ft �gb.Yb
Se aratio� 3.14 ft 2'iuin
Directions:
Play with cell length to get desired ceii spacing. length and width. Remember system SHOULD be longer than it is
wide. It must also Satisf basal loadin rate and GeoMat cell loadin rate.
Project: STEPHEN B. 8 MARJORIE B. MOLSTAD Page 3 of 13
End Connection Lateral Layout Diagram
. . .. — . —. . . . . ._ ------------ - -- -a.w . _:. .
Hde spacirg is every 12',1/2'hole at 4 8 8 O'dock,statling 4 O'cbck 6'fran end and
8 O'docic Hdes at 12'from end.
Lateral Spacirg 0.00 R Pipe Diameter 4.00 in
IIf�011 n CYOSS ... 011
93.46% �- Finished GraAc �N'• V V'V W V
. . ... . ' . Di�buCan
I:-�-� ��. . .-... 12 -aa"� e,nn la�fll.cvd
2.96ft — S�E�°Rm°�md°d
4 �
4 in —► PIpCDLL ' � �nu ` FEuflQ�u�a
. ._+ P�R I`._
... ' . <.__..
Topofgeomattobeato ��. _ __ _ ���� � - - - � �_(�'AMAT
below original grade I � I I � I P4.�M33°p'�� � � � ' I ' � � ' C��
ia51tra5ve Smfitt
` I __-NATIVESOIL.-_c J_�
�a " � 4�c�--==___--_— r ^ t�Rc�a
�
� �ervation Pipes �
�nwao\
93.46fl �"°e°mi0e � 1�
/ I
�
��a.
12'Min. I,.... \I
48'Max. I
s°' 1 , ix.r.,�
��` i
.�. i
�is£. i
� �-,s-��.�i�
�,,.,- i - , -
���u�, �a�
�m,� 3 ���,�
89 ft
Prqect: STEPHEN B.8 MARJORtE B.MOLSTAD Pag�4 of�3
Notes/ Maintenance Requirements
MANAGEMENT PLAN
This private onsite wastewater(POWTS)has been designed,and is to be installed and maintained in accordance with SPS 383,Wis.Admin.
Code,the ir�-Grou�Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems Version 20 SPS-10705-P
(N.01/01). GeoMat in ground Component manual Version 7.
1.This POWTS has been designed to accommodate a maximum daily flow of 45�91�ns ot wastewater per day. The quality of
inFluent discharge into the POWTS treatment or dispersal component shall be equal to or less than all of the followirg.
A monthly average of 30 mglL fats,al and grease
A monNly average of 220 mglL BODS
A monthly ave2ge of 150 mg/L TSS
Wastewater shall not discharge to the POWTS in quanUties or qualities that exceed these limits or that result in exceeding the enforcement
standards and prevenfative acfion limits specified in ch.NR 140Tables 1 &2 at a point of standards application,ezcept as provided in DSPS
383.03(4).W is Admia Code.
2.The owner ot this POWTS is responsible for system operation and maintenance.
3.Defec[s or malfunctions identified during maintenance described above shall be repaired in conformance wiih SP5383 Wis.Admin.Code,
and the pertaining county Private Sewage Systems Ordinance. The users manual,provided to ihe owner of the POWTS inGudes the names
and telephone numbers of the properly licensed individuals to contact for such repairs.
5.No product for chemical or physical restoration or chemical or physical procedures tor POWTS may be used unless approved by the Dept.
ot Commerce in accordance with SPS.384,Wis.Admin.Code.
6.If the POWTS is replaced,or its use discontinued,it shall be abandoned in accortiance with SPS 383.33,Wis.Admin.Code.
NOTES
Two ETfluent Filters to be installed where possible 1 to be installed in ST,and or 1 in pump tank in
wder to insure particle size less than or equal to 1/8". Filters should be cleaned once in spring,and once in fall. Also,strainers in sinks in
Me building shall be maiMained,so that solids and fats are minimized to flow into system.
A minimum of 2 observation pipes per cell shall be installed. These pipes shall be locatetl appro�mately at the end of each cell.
The plumber,a county shall see to il that a copy of these plans including this page,maintenance folder,and maintenance agreement is
given to the homeohmer.
This system may contain a dose chambec If a pump,float,electrical oufage causes the dose fank to fill,the homeowner should see to it that
the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage.
Contact a pumper or your installer H this problem occurs.
The homeowner is responsiWe for formulating a water conservation plan that will ensure the system is rarely overloaded. 1.E.spread laundry
out over time,not 6�oads in 2 hours,while everybody showers,and uses the tdlet,ETC.
CONTINGENCY PLAN FOR COMPONENT FAILURE
A Septic Tank.My sWcturel tailure resut�ng in cracks or leaks in the tank must be corrected by replaceme�t of the septic tank component.
Leaks in Me jants between manhole nsers w wvers shall be repaired by replacing faul[y seals with approved materials to make jdnts water-
tight.
B.OuUet Filtec The outlet filter shall be replaced or repaired when d is either no longer capaWe of preventing the discharge of partiGes larger
than 1 f8 inch or when it has become permanently degraded by Gogging so as ro interfere with the desgn flow ou[of tbe septic tank.
C.Dosing chamber and pump.The dosing chamber shall be replaced rf any sWctural failure is found.Leaks in joints between manhole
risers or covers shall be repaired by replacing taulTy seals wi�h approved matenals to make joints water-tight.The pump and controls shall be
replaced when they are no longer capable of functioning according to the design plan.
D.Pressure Distribution Piping.Partial clogging of the dishibution nehvork may result in unduly long dosing cycles.The ends of the
distnbutlon lalerals may be exposed and the threaded end raps removed.The piping can be disconnected on the oWet end ot the pump.
The distribution piping may then be back Flushed to cleanse any accumulated matter from the piping.It is recommended that the dosing
chamber then be pumped by a licensed plumber.
E.Soil Absorption Cell.The discharge of sewage or wastewater to the grourM surface is strictly pronibited due to the human heatth hazard
created by the effluent.NI failures created by surface discharge shall immediately be reported to the appropriate coufriy.The p�mp shall
then be immediately disconnected to prevent fudher discharge to the ground surface via the soil absorption cell.The enisting septic tank and
dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorption cell can be achieved.The
replacement shall be initiated only aker any necessary plan approvals have been obtained finm the
appropriate plan review authority and the required sanitary permit is obtained finm the county.
Project: STEPHEN B. & MARJORIE B. MOLSTAD Page 5 of 13
In Ground System Maintenance and Operation Specifications
Service Provider's Name RED'S SEPTIC SERVICE � Phone 715-798-303:
POWTS Regulators Name Sa er Coun SPIA-Zonmq Administration . Phone (715)634-82R8;
Svstem Flow and Load Parameters
Design Flow-Peak 450 gpd Maximum Influent Partide Size 1/8 in
Estimated Flow-Average 300 gpd Mauimum BOD5 30 mg/L
Septic Tank Capadty 1000 gal Maximum TSS 30 mg/L
Soil Absorption Component Size 227.5 ftZ Maximum FOG 10 mg/L
Type of Wastewater pomestic Maximum Fecal Coliform 10E4 cfu1100 mL
Service Freauencv
Septic and Pump Tank Ins ect and/or service once every 3 years
Eifluent Fitter Ins and dean as necessa at least once eve 3 ars
Pump and Controls Test once eve 3 ears
Alarm Should test periodically
Pressure System Laterals should be flushed and ressure tested eve 3 ears
In Ground Ins ect for pondin�and_seepa�c e once eve 3 ears
Miscellaneous Construdion and Materials Standards
1. Observation pipes are slotted and materiais conform to Table SPS 384.30-1, have a watertight cap
and are secured in as shown in the GeoMat In Ground Component Manual Ver. March 20,2017.
2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMa[In Ground Component
Manual Ver. March 20,2017. Media is covered with an approved geotextile fabric.
3. All gravity and pressure piping materials confortn to the requirements in SPS 384,Wis.Adm.Code.
4. Sca�cation of basal area is accomplished with a rake or other tool.
5. AII disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration.
Lateral Turn-up DeWil
�� 6-8"Diameter Finished Threaded Cleanout
��. Lawn Sprinkler Grade \ Plug or Ball Valve
Box \
y
� Lateral Ends at Last Orifice Where
Long Sweep 90 or Two
�45 Degree Bends Same
Diameter as Lateral
'i�i,1 ' _.',__ .�.. . .
�Distribution Lateral � Lateral Cleanout �
89 Feet
Project: STEPHEN B.&MARJORIE B.MOLSTAD Page 6 of 13
GeoMffi WaMbution Ceil Media Layout
325 CeII Width(k) 2.63 Sidewall to Lateral(k)
Distribution Cell Cross-section Arrangements
Y��Y
ComponeM Legend " ��� �
0 Distribution Pipe
GeoMat is covered wi�h approved geote.xtile fa0ric as per ihe their protlucl approval.
Distribution Cell Plan View Layout-Typical
325 CeN Widtl�-A(fl) 70.00 Cell Length-B(ft)
End Connecbon Late�a�Layout Diagrdm
l.� � � � � � � � �� �� � � � � � ��'.
Typieal Dispersal Cell
Finished GnAc �1'r �'�'Y W V
D�m
I ': : �� � �� 1i -4s�� '- n.nre �. I�ilLevd
Smd Ca�s�ao�maed
I/ �u T
� pqieIha . .�'f u:v ��Y6
pR� . r�o� � � /Fah`ie
�
.�, �� _ - _ ..; . � GFAMAT
I � I � I � I GZ�ASTM 33 3s+ � � � � � ' � ' I iafilttive Surface
� I ___-NATIVESOfL=- ====J�
� `-- - - - - ---�— --___� iar.e�GF�
See tlelaiLs m page 4 far rurtiber.s¢e.and spacirg W laterals.
Project: STEPHEN 8.&MARJORIE B.MOLSTAD Page 7 of 73
Plot Plan � � � �3
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PROPERTY OWNER: �7�PriE.N $. � /�11�2µ��E R. /��I GL5(tkD 1" = 40 FT.
(euapt wherr nacad)
legal Desaiption: (�K7. 1-�oYf. Lffr i, Lefs 4 � �ft Csn��! l763 V5,�3z.3 LoT48 p =��Ptt
CsM �k �BLI��18 P448 SEC. U'> T41..61. fio4W� Tou�rJ oF LEnlRaot; L 850 �1CT�S
S�1wyER Cou�'N� W�sCon��nl OW9y{D35lns� >>�sz.�,1 erH T
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'�'-'''""'E',' PRIVATE ONSITE WASTE TREATMENT �ounty
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� \ SYSTEMS
`�~;�Sps\J",� Sawyer
\�� �;;, ( POWTS)
�ti Fy---
�s,�-,a�;,.���,
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� � 3�q
Personal infonnation you providc may be used for secondary purposes(Piivacy Law,s. L5.04(1)(m)] �
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
� �- �l a r o�Yz. �a(s�ad� �,roo ^
Insp BM Elev: BM Description: Parcel Tax No:
r
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TANK INFO MATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �� �� �� Benchmark ��fl �
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet q�;qa�
TANKTO P/L WELL BLDG VENTTO ROAD �I�1et--�� sr/ q�5',q �
AIR INTAKE
Septic NA o,�-�-- y��'$S�
Dosing NA installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe �,c��
PUMP 151PHON INFORMATION Surface e E��o `
Manufacturer Demand Final Grade
Model Number GPM C3 `r� •'o �
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N ��.�` L F� ` #of Cells � Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav A� Conv ❑ Aggregate ��a�q�
INFORMATION P/L Bldg Well Waters ° �GP ❑ Chamber Model Number:
❑ AG ❑ EZFiow
CELL TO � �,�.5 �-�` .�—� ❑ Mound � Other
- -- ---_ --_ _ _— ---- -----
_ ---
DISTRIBUTION SYSTEM X Pressure Systems Only
_ __--
Header/Manifold Distnbution 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___ _ � 0 Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies,persons present,etc.)
�'c�s�l� 1�-( 21a�
� R e,w (n2 0�`� C�=1 I �'�1�/'C�CtS C_
Plan revision required?�Yes 0 No i
�3 �3 a3 ----�� _ _ _--� 6���� �
Use other side for adtlitional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
5A PEAMIT NUMBER: �� �3�q
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