HomeMy WebLinkAbout002-121-18-1500-SAN-2022-345 � � � � Industry Services Division Counry ��
� 4822 Madison Yards Way SaWy2f �
,SP ' Madison,WI�370� Sanitary Permit Number(to be tilled in by G �
: P.O.E3ox 7302
Madison,WI�3707 (� ? (I �� � �
Sanitary Permit Application s�`�`��'���°'°`"°�""",h`� �
In accordance with SPS 383 21(2),Wis Adm Code,submission oY this form to the appropriate govemmental unit ► ' '�� � ������ � �
is required prior to obtaining a sanitary permft Note:Application forms for state-owned POWTS are submitted to Project nddress(if different thun mailine add..,..
the Department of Safety and Professional Services Personal information you provide may be used tor secondary �ame
purposes in accordance with the Privacy Law,s. 15 04(I)(m),Stats.
I.Application Information-Please Print All Information
Property O�cner�s Name Parcel#
Robert Hammond 002121181500
Property O�vnePs Mailine Address Propertg Location
14392W County Hwy K Govt.Lot
City,State Zip Code Phone Number
Hayward, WI 54843 651-338-7532 ��^� '�, Section 30
II.Type of Building(check all that apply) Lot# T 40 � k OS E or
�I or 2 Family D�velling-Number ofBedrooms 2 ��'23 Subdivision Name
Restaurant Bathroom Waste Block# Community Beach
�Public/Commemial-Describe Use �
�Ciry of _
�State Owned-Describe Use CSM Number �Villa�e of
�Town of Bass Lake
Ili.Type of POWTS PermiL•(Check either"New"or"Replacement"and other applicable on line A. Check one bos on line B.Complete line C if
a licable.)
�� �New�System Re lacement S stem Other Modification to Existin S�stem ex lain Additional Pretreatment Unit ex lain
� p Y � € Y� ( p ) ❑ ( P )
B' �Holding Tank �[n-Ground �At-Grade �Mound �Individual Site Desisn Other T��pe(e�pl�in)
(conventional)
�'• ❑Renewal Before �Revision �Chanee of Plumber �fransfer to Ne�v O�cner�'�st Previous Permit Numbcr and Date[ssued
Expiration N/q
IV.Dispersal/Treatment Area and Tank Information:
Desi�n Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(st� Dispersal Area Proposed(st) Sy�stem Glevation
946.5 0.7 1353 1400 93.5
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o ',n, o
U �' u � ^ %n
Ncw Tanka F.�istine Tanks `� � u - � �
- J rn r ✓: i: C7 -
Septic or Holding Tank 2000 2000 1 Wieser ✓ 0
Dosing Chamber � � �
V.Responsibility Statement- I,the undersigned,assume responsibili for installation of the PO�YTS shown on the attached plans.
Plumber�s Name(Print) Plumber�s Siena � MP/MPRS Numbcr E�usiness Phone Number
�+a
�-�.--;�;`--,�,y"'
Jason Kuettel ::�<;,:k.�; 675751 715-798-3355
Plumber's Address(Street,City,State,Zip Code)
PO Box 66 Cable, WI 54821
VI.Coun �/Department Use Only
Permit Fee Date Issued Issuina Agent Signature
��p ro� ❑ Disapproved $ � , ` -� � � _
��, y�D. 1 :,����. ��- ��j��:�,�����f-�.�;����
❑Owner Given Reason for Denial
Conditions ofApprovaUReasons for Disapproval ',i t��'(!��! ;��:, ,
it f�,�.;
f=-1 � ' ; ,. ,, I "' ', _ , _. _. _ .
:J:.'-,.:..,,...1.�� I�� ��� 1 {t�
1
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C p� s e.`'`1 � ���'��c-� ��- ,E .
_ � � �. .�_�..� ;+ }j , _
Attach to complete plans for[he s��s[em and submi[to[he Counh�onk on paper not less than S 1/2 s l l inches in size -,z��v
SBD-6398(R.02/22)
tJ0 R�FJhDS AFTER
15S�J�OF PERtJ�IT
.\`.�'\K I\I`��.
Wisconsin Department of Safety and Professional Services ;.�/ ��. Phone:608-266-?l 12
Division of[ndustry Services �� �i Web:http:i/dsps.wi,gov
4822 Madison Yards Way r�� � �'� Email:dsns c(�i-wisconsin.Qov
PO Box 7302 't �� pS
Madison,WI 53707 �t� `- Tony Evers,Governor
'� �_ _
��,;�. �,`�� Dan Hereth,Secretary
December 13, 2022 Conditionally
APPROVED
CONDITIONAL APPROVAL DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
PLAN APPROVAL EXPIRES: 2024-12-13 DIVISIpN OF INDUSTRY SERVtCES
Plan Review: PWTS- ('��p�p3,..0
�� � �����
Jason Kuettel
__ .__ ___ --------------- -- ---- _
PO Box 66 SEE CORRESPONDENCE
Cable,WI
SITE:
Robert Hammond
14392W County Hwy K
Sawyer County
Town of Bass Lake
530 T40 R8W
FOR:
�Description: 946.5 GPD—98"to limiting factor— ' I In-Ground Soil Absorption Component Manual 5/22-
Effluent Filter- Maintenance required— 5/27
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes.The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and
located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The
owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06.
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• If using the existing septic tank, it must be inspected for watertightness and structural soundness,size and
baffles,and must be brought into conformance with the requirements of ch. SPS 383,Wis. Adm. Code.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19,Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats.
• A state approved effluent filter is required.Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• A copv of the approved plans,specifications and this letter shall be on-site durina construction and open to
inspection by authorized representatives of the Department,which mav include local inspectors.
Owner Responsibilities
• The current owner,and each subsequent owner,shall receive a copy of this letter.Owners shall also receive a
copy of the appropriate operation and maintenance manual(s)and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s.SPS
383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard,the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes.Reports shall be submitted at intervals appropriate for the component(s)utilized
in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall
relieve the designer of the responsibility for designing a safe building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address
on thisletterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation,operation or maintenance of the POWTS.
Sincerely,
,jd��wcw/�v�ul�y
Joshua Rowley
POWTS Plan Reviewer,Division of Industry Services
(715)813-9111 joshua.rowlevC�wisconsin.gov
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manua/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
The Boulevard
Owner Name(s): Robert Hammond Phone: 651 _338 _7532
Owner Address: 14392W County Hwy K Hayward, WI Zip; 54843
Project Address: Same
Govt. Lot: 1/4 of__ 1/4, Section 30 T40 N-R�$ E�or W ❑✓
Township: Bass Lake County: Sawyer
Project Parcel ID #: 002121181500
Designer Information
Designer Name: �ason Kuettel Phone: �15 _798 _3355
Designer Address: PO Box 66 Cabie, WI Zip; 548Z�
E-mail: tim@andryras.com
Conditionally
License Number: 675751 APPROVED
DEPT OF SAFETY AND PROFESSIONAL
R@mar{(S: SERVICES
f>NISION OF MDUSTR� SFRVIl1f-�
O� �
SFF r�.ORRE`,�����Nt�� rai.r�
�� s
Signature: ��i,.�/�� __ Date: /2 �1 z�.z 1
Original sigq tu required on each submitted copy.
CHECK 60%AS APPLIGIOLE. CHECK BC%NS>PPLIC4G�E
❑ SOIL EVALUATION s��e: �° =ao a SYSTEM PAGE 2 OF
SITE MAP o ao 6o e0 pLOT PLAN
PROJECT NAME (�� c
�10 tl gnA; �Q+ DESIGN FLO`P/ ��% � � GPD
/�4�L-v A/� i� �2l-�7�1� �--)�� � Attach design flow calculations for commercial plans.
aRo.lECi qDDREss /��3�i Ztv � c.. -' � 11�� T 1� Pipe Material/ASTM Standard(Tables 384.30-3 8 384 30-5)
N Sanitary Sewer�� f�� J��\ /
BM Symbol �1 BM Elevation� ���`� � FT /
Face Mam. N�t
BMDescnplion'. �c:C.K. C.J.L�ct "� L`I V'�� W- r C.IC• , ��
Siope Gratlienl(%) i�aicaie�onn oy I MPORTANT:
o!Tested Area z � We��Symbd(if applicaGle) � tlrawing an arrow Show ground elevalion contours at suilable in�ervals.
on iM1e appmptlle fne.
�7bVr' l/L � �Z_(.'.3tC-j f-t�}n�./il, '�
;1�')�ZISS ' �NSiZW L�'� -� �Y fiC� 1 l� fr°s i�-' /+�`� G � i
i �. L� /�'� '. (_.�i..,N..,i..\v `/ /3L�1eH Lc��-r IS Z3 1311L �, I
S 3�.� i y��N rZc��� � �
��i� � �� O( ZIZ// b' /5�-c"> � SAw�t_� , Lo �jz+��r� �, �- �5�,}s � � .3kc �
� /3, �- i�, 2z � �
j NG?7H � �
I Q� • � 7. 1 S . � 2/� i
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i �,� s,s,rti « - 77 �! CN��-� ----
� � s � <: s ��� � ��'� ---- i
S"`(s� Cc 7�.5 f«�fa,..�
I � All HSW goes to 1000 gallon grease trap
I � T_ —� and proposed 2000 gallon HT, see I
i separate approval. n
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� � C )5751 - - --- �
� ��u �Z �
IN-GR�UND CRAVITY DISPERSAL AREA SePt'° Ta"kcS' ""a"�'a�t��e�:
Wieser
Uniform Elevation Trenches with EZ1203HP Bundles
Septic Tank(s) Volume(s):
3-ft Trench (down-sizing credit) Zooa
gal gat gal gal
Effluent Filter Manufacturer.
. Orenco
� min. �2" Effluent Filter Model #: �T-OHZ2
Geotextile I (typical)
Cover
SOILCOVER TYPICAL TRENCH
min.lt ench • ; . CROSS SECTION VIEW
depth � �� � � ; . (No Scale)
(rypical) —T — —. . •, r::• :- OBSERVATION PIPE DETAIL
' a•� (NoScale)
System Elevation/%��-� it. � � •,• f' Screw-Typeor -
Stip Cap (loose) ,�. W�W:�� ---Finished Grade
(typical) � � Provide minimum 3 ft (mulched 8 seeded)
. .• .
•. ..
separation between trenches, o���PVC Plpe ' ` �f_ Topsoil Cover
Top ot pipe to�terminate �'� � , i�� (min. 'I foot)
at or above tinished grade � '` " � ��
(4) 1/4"-112"X 6"Sbts
TYP I CAL TRENCH (show Iocation of in�et � out�et pipe connection on plan view.) � �b apart
PLAN VIEW �� �
•,�Y�• I• :
Anchoring Device ... •.•:..' ' Infiltration
4�� � Observalion plpe shall be instatled SuAace
(No Scale) Perforated Lateral atjundionbetweentwounits. � Q ft
Observation Pipe t ical
(typical} {typical) � YP )
- - - - - - - - - - - - - -�'� - - - - - - - - - - - - - - -
r — - - - - �
I =_____ _______ =-___ __ ___ _—=____ ==_==__= ( A = 3.0 ft �
� - - - - - - - - - - - - - - - �.�— - - - - - - - - - - - - - - - J c�yp���� m
�- 6 = �� ft - - - - I c,a
(typical) O
INSTALL PER TRENCH; EZ1203H Bundle �
(typical) �
7 10-ft bundles @ 50 f� EISA/unit = 350 f�� (mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturers instrucUons.
+ 5-ft bundles @ 25 f� EISA/unit = ftz
= Proposed EISA per trench = 350 ft2 Required Infiltration Area = 1353 ft2 Distribution Method:
x `1 trenches = Proposed Total EISA = 1400 ft2 branched manifold
RESET ;�
HSW Holding Tank
Source Estimated Flow Uni[ Total
Bar/Bar Seating(no Meals) 4 GPD per seat 10 Seats 40 GPD
Bar/Bar Seating(with meals paper waste)High Top 8 GPD per seat 10 Seats 80 GPD
Res[aurant Kitchen Waste ONLY without dishwasher and food waste grinder G GPD per seat 28 Sea[s 112 GPD
I loor Drains(2) 25 GPO per drain 2 Each 50 GPD
*"**1000 Gal Concrete tank existing for grease interceptor"**
lat�IHnlding7:ink 7R2 GI'D
'•'•2000 Gal Holding Tank being Added'** '�x lol�l I:stimated GPD 7410 GPD Minimum Nolding('ank Vnluma 1t)net c,,il
Residential Strength Tank&Drainfield Sizing
source Estfmated Flow Unit TOtal x1.5
Restaurant(E3athroom Waste only 2S seats) 14 GPD per seat Z8 Seats 392 GPD 588 GPD
(`mpleyees(3) 13 GPD per employee 3 Emplayees 39 GPD 58.5 GPD
�'�ed upstairs Residence{3p0 GPD) 3p0 GPD
'•*Drainfield Sizing"* 7otal Oesign Gpp for Drainfirld �46.5 CPD
Drainfield Sizing'""""See attached EZ Flow Dispersal Page"""
Soii Loadir�p Rate QJ 1352.143 5F Minimurrr Sizing
""*"Saptic Tank Sizing-2000 Gal'"*•" *'*Tank Sizin&'•' 94G5 GPD x 2.�AR 1976.292 Gal Minimum
PAGE40F4
In-ground Gravity Management Plan
tMPORTANT:
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 maintai�ed 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 = 946.5 gpd� BODS 5 220 mgL"'; TSS 5150 mgL"'; FOG <_ 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o fype 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 specification}
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAlN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s)shall be pumped by a eertified septage servicing operator licensed under s. 281.48 Wis.
Stats.when the volume of solids in the tank(sj 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 sha(I be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
Systetn maintenunce f�e�or�s shall ue subii�iiied io ci�e proper {ocal yovernment unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: AndrY RaSt1lUSS@Il Sc SOC1S Phone: 715-798-3355
Local government unit: SaWyer C0. ZOII'111g Phone: 175-634-8288
Local government unit address: 1061 O Malrl St. #49. HayWa1'd, WI Z1P: 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 tivith 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.
Continqency 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.
System Abandonment
If use of this PO���/TS is discontinued, it shall be abandoned in accord�nce �vith SPS 383.33, Wisc. Admin. Code.
"""��� PRIVATE ONSITE WASTE TREATMENT county
_-���,SP ,�; SYSTEMS
$ ( POWTS) Sawyer
`�k �—�i'
""�"`" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �,�`�S'
Personal infonnation you provide may bc used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village (�Town of: State Plan Transaction ID#:
�e�e1�- �aw�►+tivn� -�t.S�S �l�A �"�.'1��G�-5b3^ C--
Insp BM Elev: BM Description: Parcel Tax No:
(oo .d ' �� c o�s' ��- I�-I- I -l'��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,• �o Benchmark ,� �
Dosing
Aeration Bidg. Sewer q S;s- �
Holding St/Ht Inlet �y,9 '
TANK SETBACK INFORMATION St/Ht Outlet �Y,� '
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic ��' -t-�' +S� .t..s� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 43,5�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative y�..7 �
Su rface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Weli
DISPERSAL CELL INFOR ATI N
DIMENSIONS �N � L 7�` �� �� � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P�L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG 6� EZFIow
CELL TO a-'S �- �I/ ❑ Mound o Other
- --- — —�—__ _ __---- ---
_ _--_. _ _-
DISTRIBUTION SYST M X Pressure Systems Only
- -- ---- -- —
Header/Manifold Distribution Pipe(s) i X Hole Size X Hole Observation Pipe�
Length Dia Length Dia Spac , Spacing ❑Yes ❑ No
---- �----- �
------ - - -- ----_ --
SOIL COVER
- - —---. _ _--
Depth Over Depth Over � Depth of Seeded/Sodded Mulched
Cell Center � Cell Edges i Topsoil __ _� ❑Yes ❑ No T p Yes ❑ No l
COMMENTS: (Include code discrepancies, persons present, etc.)
�S� � �� ( z3
�" -� ��.f d a. �.
Plan revision re uired?�Yes ❑ No � � � I I � I
I
q ,a� �2 zy j __�� ��� ! �����
_--,-- �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: �Z ' 3�{�
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