HomeMy WebLinkAbout024-741-30-5505-SAN-2022-340 „�;j�''^a"_'�ij�, Industry Services Division Counry �
_ � 4822 Madison Yards Way S8Wy2f �
- ��,�5 �'-' Madison,WI 53705 Sanitary Permit Number(to be filled in by
� pS : P.O.Box 7302
`;, ,: ,. .� Madison,WI 53707 � j�j i ��” �
State Transaction Number �
Sanitary Permit Application �,.►
�
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis fonn to the appropriate govemmental unit �
is requircd prior to obtaining a sanitary permit Note:Application forms for state-o��med POWTS are submitted to Project Address(if different than mailing a �
the Department of Safcty and Professional Servicea Personal infonnation you provide may bc uscd for secondary ������ ����+���� p�
purposes in accocdance���ith the Privacy I.a�a�,s.15.04(I)(m),Stats_ �� �1
1.Application Information-Please Print All Information
Property Owner's Name Parcel#
PAUL PETERSON 024-741-30-5505
Property Owner's Mailing Address Property Location
2362 WESTON RIDGE CT �o�, L�� PRT5
City,State Zip Code Phone Number
CHASKA, MN 55318 � �s��t'°" 30
II.Type of I3uilding(check all that apply) I.ot# T 41 N R �� E or W
�l or 2 Pamily Dwelling-Number ofBedrooms '� Subdivision Name ^_
I31ock#
�Public/Commercial-Describe Use
�- �City of
�State O�tined-Describe Use CSM Number �Village of
5�`37 #��7 QTown of ROUND LAKE
IQ.Type of PO�i'TS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A' New S�stem Re lacement S stem Other Modification to F_xistin S stem �x lain Additional Pretrcatmcnt Unit ex lam
) P Y � Y (' P ) ❑ ( P )
g' �Holding Tank �In-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain)
(conventional)
�'• ❑Rencw�al Before �Revision �Change of Plumber �ransfer to Ne���O���ner��ist Previous Permit Number and Date Issued
Gapiration (,�y�k. �
IV.Dispersal/Treatment Area and"I'ank Information: ,
Design Flow(gpd) Design Soil npplication Rate(gpd/st) Dispersal Arca Requircd(s� Dispersal Area Proposed(s1) System filcvation
300 0.7 429 504 95.00'
Capaciry in Total #of Manufacturer
I�ank Infonnation Gallons Gallons Units � � o ",�, o
New Tanks Esis[in�Tanks '«° �' U
€ � o :: � � � �a �
a U v� h v: c= C7 a
Scptic or Holding Tank 750 750 1 WIESER CONCRETE ✓ �
Dosin��Chaimbcr � � �
V.Responsibility Statement-I,the undersigned,assume ponsibility or n, Ilation of the POWTS sho�rn on the attached plans.
Plinnber's Name(Print) Plumber� gnature MP/MPRS Number Business Phone Number
Travis Butterfield - 652879 715-634-8176
Plumber's Address(Street,Ciry,State,Zip Code)
14346W St. Rd. 77, Hayward, WI 54843
VI.Co ty/Department Use Only
�App � ❑Disapproved Pennit I�ec Date Issued Issuing n�ent Signature
,(�'V ❑Owner Given Reason for Uenial $ `�'�b � `~ ��`t I,t :- 'y'�,�.�-i i l�%�-C_�'jT.ti�v<__..�_
Conditions of Approbal/Reasons for Disapproval
� � � � �- `i ��� � � � ��5���,�
, ; :; {� 1�8t���..... .�,,..._ Il
� t����► S U
� �
"' ��k� a`� -�- DEC 0 7 2022
�� �� C \ `���-i( o
,- �.� l� -�; .`��# �et,� uJo r t c�
� SAWYER CJi.if�37Y
Attach to wmplete plans for the sys[em and submit to the County only on paper not less than S l/2 x 11 inches m size ,_
��,�- '?`)
SBD-6398(R.02/22)
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
Peterson
Owner Name(s): PAUL PETERSON Phone: - -
Owner Address: 2362 WESTON RIDGE CT, CHASKA, MN Zip; 55318
Project Address: 10265N COMSTOCK RD, HAYWARD, WI 54843
Govt. Lot: 5 1/4 of 1/4, Section 30 , T41 N-R 07 E❑or W ❑✓
Township: Round Lake county: Sawyer
Project Parcel ID #: 024741305505
Designer Information
Designer Name: Travis Butterfield Phone: 715 _634 _8176
Designer Address: 14346W St. Rd. 77, Hayward, WI Zip; 54843
E-mail: office@butterfielddrilling.com ���i„�s�,a�e re5er,��a ro��aE����<��<<ti st��t,�p.
License Number: 542879
Remarks:
�a _ � - aa
Signature: Date:
Original signature required on each submitted copy.
CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE.
� SOIL EVALUATION o sca�e: ao 40 so 80 � SYSTEM PAGE 2 OF �}
SITE MAP PLOT PLAN
PROJECT NAME: 3vt.�
10Z DESIGN FLOW: GPD
Pcto. � �'e�e�Sa✓1 Attach design flow calculations for commercial plans.
PRo�ECT ADDRESS ����� �^'�S1L G�- Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
NSanitary Sewer:�/
BM Symbol:� BM Elevation: �V��� FT �_
I ��Q ,/��, Force Main /
BM Description: �Q�` r� I�t( �"�` �'"� �
Slo e Gfadlent % Indicatenorthby IMPORTANT:
P � � Well Sym6ol(if applicable): � drawing an arrow Show ground elevation contours at suitable intervals.
of Tested A�ea: on the approprite line.
�.��.� L�= -_,
- � � _
...
��� \\\.
�
/ ' ,
���
I Y . 3 � b�'w,,�
.y `� St"
I^{ °1 ��
lr�r� �U i ��5
�► �` � ; ; � ; -
r ���� �"" � �� � �
,
99,n `�� �°�' 7�Z� � � w��,t� ���
�� ���� ��,
`D ay Q,�<<� � Pl.�
��- �t,� �� i��f � ��
� y�. �
S�yS �e� �� .
`��
�---__--_�
�
�- :
���s�'
fa�t �e�v-sv�
a 3�a c�efl�., �'�'� ��
���N j �yt2�'✓ S�S�31� �lZi.Jl�S �jw^�'�P1�'����-�l
�� c�a��yi3 ��s�� ��'�;5 ���as�9
j 3o TY� N i� D�
�(��.,i• v� (���� La,�..
Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) 750
gal gal gal gal
Effluent Filter Manufacturer:
BeSt
I
Effl�er,t F�iter nnodei#: Gf 10-8
min.12"
SOIL COVER (typlcal)
12"
min.trench
depth •
�riP��a�� ��. • � TYPICAL TRENCH
� • . --� �� �� ��°��a��•. CROSS SECTION VIEW
r 34„ •'• .. . •
(typical) •` • . �NO SCB�G�
w �• ' e
. • ° Provide minimum 3 ft
System Elevation = 95.00 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe nPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (rypical)
Install per manufactureYs PLAN VIEW
instructions. �NO SCB�@�
� - - - - - - - - - - �� - - - - - - - �� - - - - - - - - - — �
� , � I �A= 3.0ft
� - - - - - - - - -- - - - � (tYPical) �
- - - -�� - - - - - - - �� - - - - y
B = 24 ft - I r�n
(rypical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typicap �
(mfd by InfiltratorSystems,Inc.) �
Install pursuant to manufacturer's instructions.
6 Quick4 Std-W @ 20 fP EISA/chamber= 120 ftz �A
+ � Pairs of end caps @ 6 ftz EISA/pair= 6 ftZ
= Proposed EISA per trench = �26 ftZ Required Infiltration Area = 429 ftz Distribution Method:
x 4 trenches = Proposed Total EISA = 504 ftz 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,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 Operatinq Limits:
Design Flow= 300 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 negleci 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 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(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 filterlsl shall be inspected every 3 years and shall be deaned 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:TfBVIS BUtt@I-fl@Id Phone: 7�5-634-$�76
�o�ai 9o�e��me�t u�;t: Sawyer County Zoning &Conservation Pno�e: 715-634-8288
�oca�9o�ernment unit address: 10610 Maln St, Suite 49, Hayward,WI ZiP 54843
Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisa 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 falled 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.