HomeMy WebLinkAbout008-937-19-5407-SAN-2023-001 � ,
/`'-'"''"\, Department of Safety c°�"ry �'�
- Sawyer �
� � = & Professional Services, �
; � _' - Sanitary Permit Number(to be fiiled in by�
� = Industry Services Division / /�
/�''��,,'. � ;N`�� lY ��� � 1 /� �.�1 .
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Sanitary Permit Application State Transaction Number �
�
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �"'�
is required prior to obtaining a sanitary permit Note:Application forms for state-owned POWTS are submitted to Project Address(if difTerent than mailing a ��
the Department of Safet} and Professional Services Personal mformation you provide may be used for secondary --
purposes in accordance with the Privacy Law,s 15.04(1)(m),Stau. 1097N Hillside Ln.
L Application Information—Please Print All Information
Property Owner's Name Parcel#
Daniel Daht 008937195407
Property Owner's Mailing Address Property Location
1097N Hillside Ln. 4
Govt.Lot
City,State Zip Code Phone Number
Birchwood WI 5481 '/., '/, Section 19
IL Type of Building(check all that apply) Lot# T 37 N R 09 E or W
�r2FamilyDwelling—NumberofBedrooms 3 SubdivisionName
Block#
❑Public/Commercial—Describe Use
� ❑City of _
❑State Owned—DescribeUse CSM Number ❑Village of _
�— �Town of Edgewater _
III.Type of POWTS Permit:(Check eit6er"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i
a licable.
A' ❑ New System eplacement System ❑ Other Modification to Existing System(explain) ❑ Additional PreVeatment Unit(erplain)
B� ❑ Holding Tank �In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design yp ( p )
❑ Other T e ex laui
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Permi[Number and Date Issued
❑ Transfer to New Owner
Expiration LII�`,[ ,�
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
450 7 643 678 � �+I • /�7 I F•�
J
Capaciry in Total #of Manufacturer
:3
Tank Information Gallons Gailons Units � U v '$ N �
New Tanks Existing Tanks � o v � � � � "�
a U v� � rn w C7 i
Sepuc or Holding Tank �ppp 1000 1 Wieser }{
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibiliry for instaltarion of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signa MP/MPRS Number Business Phone N�mber
Rick Brown 231251 71�-419-0739
Plumber's Address(SVeet,City,State,Zip Code)
PO Box 637 Spooner WI 54868
VI.Co n /Department Use Only
�A v ❑Disa roved Permit Fee Da[e Issued Issuing Agent Signature '
� ❑OwnepGiven Reason for Deniai $��'� � � �� ( `'���� ����`��`�����u`�
Conditions of A proval/Reasons for Disapproval D L_:p+; i�
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''r�' �hk# _ �� �o� _ NOV 2 8 2022
__�
1 � �L�'R�`N�.��t i,�v� i°� �� SAWYER C�`,� f
C ST .�� — C�J L ` � ��1 ZONING ADM�I��"nfa;lv��
Attach to complete � ste b ' t ly on paper not less than 8�/2 a I1 inches in size ��� i���
r
`
sBD-639a�R.o3izz� ,JqN 0 3 `��3 NO R�FJNDS AFTER
ISSUE OF PER�'V�IT
�+,WYER COUNTY
7ci�+ttRK�ADM1NlSTRATION
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
Dahl
Owner Name(s): Daniel Dahl Phone: - -
Owner Address: 1097N Hillside Ln.Birchwood WI Z�p: 54817
Project Address: 1097N Hi�lside Ln.Bichwood WI 54817
Govt.Lot: 4 1/4 of 1/4,Section�9 ,T 3� N-R 9 E❑or W❑✓
—
Township: Edgewater County: Sawyer
Project Parcel ID#: 008937195407
Designer Information
Designer Name: Rick Brown Phone: �15 _419 _0739
Designer Address: PO Box 637 Spooner WI ZiP; 54801
E-mail: rickbrown2004@hotmail.com � ., . ,
License Number: 231251
Remarks:
Signature: �f'"'" l' °�Date: 11/23/22
Ongin I signature required on each submRted copy.
I �NECNBOXeSIpP.IC41lf. CMECN80%�S��LICABLE.
SOIL EVALUATION s��1e ,"°°O' � SYSTEM PAGE 2 OF 4
SITE MAP � �� � � PLOT PLAN �
PROJECTNAME: ��o��� o, DESIGNPLOW: 4SO cw I
Daniel Dahi Atlech deaign flow calculalions for wmmerdal pla�s.
IPROJFCi nODRESS 1097N Hillsid¢Ln. Bi�GhwoOd W I � Plpa Ma�edal/ASTM S�andaM(Tades 361.343 6 384.345)
ISs�tlarySew:r: 4 /
RNSym:w�.� BMElevalon: 100 F7 �vmM�h'. I
� eu oeu:nn!ol+�. 8ottom of Garege Siding
�„��o��y� IMPORIAN7:
iSiooe c,aa�x;r:l wNi symea(n app'�irawe)� O a�awi�p e�.,w� SMw giound elevatlon contourz at sultable Intervak.
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IN-GRQUND GRAVITY DISPERSAL AREA Wieser ��`>t�� -a�,;rs; �����t����
Ur�if�rr� E(evation Tren�hes with Quick� Standard-W Chambers �o�t,� T��,,,��;��.�,,��;:
3-ft Trench {dc►wn-sizing credit} � 000 ��, ��, :�, �,
� �`fluent Fifter Flarx,��?�;«r
� Pa[ulock
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�ffluent �iiter t��oaW �: PL-52�
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SC�.. �Ol�R . ff��.a6j .
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- � CRC�SS SECTION VIEW
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F----th�� .—�--i ` (NO Scafe)
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t' ' R P�4Y1�$ CTile'�SftT1Ui77 � �.
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System Eievation = g 1� �� ft separation betvreen trerches.
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�. w:! E-� Cap o�E�,acri;at� TYP(CAL TRENCH
� �,����� �Siio��v i��#ion �� :ntet I os�kJet pipe co�nedion on pian vi�.} ryyr��
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, � __ ��Mel�+ �''.��.�.7�` _ _ __ � _ .: .. .7��kal�i�n���1�Y1If[�It��.+�r7�' 1 (•.is.il�� �
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t; �.��,....,,,, Q`Ji�!4 arfif-� � 2`+� f�" EISJ'�i .�['t� ^- 22� �� .�'�.
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i�#� !n �4e�r€�d:
�. x � trenc�es = �r�p�sed Tc�tal E#SA = ��__�___,, �� branche�d n�a��#t�ld
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Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank�s)Vdume(s):
3-ft Trench (down-sizing credit) �oo0 9a, gal gal gal
Effluen[Filter ManWacturer:
Polulock
i
Emuen�Fiice�Moaei#: PL-525
mio.ir
SOIL COVER Irypl�l�
12^
min.trench
depth
ina��ii • TYPICAL TRENCH
CROSS SECTION VIEW
F`�ryP,� (No Scale)
���, � Provide minimum 3 ft
System Elevation=90.0 ft separation between trenches.
(typical)
Quick4 Standard-W
w/end Cap Observa[bnPlpe TYPICAL TRENCH
t ical (Show location of inlet/outlet pipe connection on plan view.) (ryv��)
(YP > i�scanPa�ma�W�m�rs pLAN VIEW
irea�onoos.
(No Scale)
r- ----------�f--------��--------- —, 1
, � �. �, �, A=3.0 ft
L----------- (NPiwp �
-��-------�'�----- ------� D
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B- �5 ft ----_; m
(typical) Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: �mra bY i�mo-a�o�sys�ems,mo.� �
Install pursuant to manufacturefs instructions. �
11 Quick4 Std-W @ 20 ft'EISA/chamber= 220 ft'
+ �Pairs of end caps @ 6 ft'EISAlpair= 6•0 ft'
=Proposed EISA per trench= 226 ft' Required Infiltration Area= 643 g° Distribution Method:
x 3 trenches=Proposed Total EISA= s�a ft= branched manifold
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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 Disaersal Area Oaeratinq Limits:
Design Flow= 450 yPd; BODS<_220 mgL''; TSS_< 150 mgL''; FOG <_30 mgL"'
Insoection 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 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 MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tankls)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 filter(sl shall be inspected every 3 years and shall be cleaned 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: Ken Way Phone: �15-234-7677
Local government unit: SeWyef COullty ZOfllflg Phone: 715-634-8288
�oca� go�ernment unit address: 10610 Main St. Suit 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.
' "'`"``'; PRIVATE ONSITE WASTE TREATMENT county
�����$ SYSTEMS Sawyer
P S �'
.
( POWTSj
��
�\kUTL,`. .�`"i
` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 3 — � I
Personal infonnaYion you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�vl�e- �a�l\ � � �_
Insp BM Elev: BM Description: Parcel Tax No:
(c�o,a' Bb�cw, o� s��,� ooS`�37- ����-`(o�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w� �a Benchmark �po,o�
Dosing �!�{t,.�wt ,�,g�(� �
Aeration Bidg. Sewer y6 •� '
Holding St/Ht Inlet �S Y �
TANK SETBACK INFORMATION St I Ht Outlet q Y',� '
TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet
AIRINTAKE
Septic '�/�� a�d' fik,` �}�� NA Dt Bottom
D�sing NA Installation
Contour
Aeration NA Header/Man. �t Y 6 �
�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM 5 y5 � ��•g�
TDH Lift Friction Loss Sys Head TDH Ft S Q�.�'
Forcemain L Dia Dist. To Well
DISPERSAL CELL INFOR TION
DIMENSIONS W 3 � �.( l,�( #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ��� ,
INFORMATION P/L Bitlg Well Waters o G � Chamber Model Number:
❑ EZFIow
CELL TO (L5 •I-�� (op� ❑ Mound-- ❑ Other - Q� �— .
DISTRIBUTION SYSTEM � X Pressure Systems Oniy
9 ' 9 - pO P X Ho Observation Pipe�
� Len�{hr/Manifold Dia �L�enn hution Pi e s Dia S ac X Hole Size !', SI Pacin9 p Yes ❑ No �
SOIL COVER
_____— - - - -
[ Depth Over Depth Over T Depth of Seeded/Sodded Mulched
Cell Center �Cell Edges � Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
� ������ ��Z�l�3
Plan revision required?❑Yes ❑ No a��l � -' � J � �jR'� � �, �
� �
—�J
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA _ -00 1
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