HomeMy WebLinkAbout002-940-07-5209-SAN-2023-006 ��' " � Industry Services Division County (�
4822 Madison Yards Way �a w .��f `�
-, ,�s p - Madison,WI 53705 Sanitary Permit Number(to be filled in b} �
_ . P.O.Box 7302
_ Madison,WI 5302 � ;j�( '� ,2?3 �
Sanitary Permit Application State Transaction Number �,�.�
i
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit Q,
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing �
the Department of Sa('ety and Professional Services.Personal information you provide may be used for secondary 8971 Cobroth Rd.
purposes in accordance with the Privaey Law,s. I 5.04(I)(m),Stats. /� �
I.Application Information-Please Print All Information (�l
Property Owner's Name Parcel# p0�- �
Kevin Schen 57-002-2-40-09-07-5-OS-002-000090
Property Owner's Mailing Address Property Location
PO Box 445
Govt.Lot 2
City,State Zip Code Phone Number
Hayward WI 54843 715-651-6770 y., '/<, Section 07
II.Type of Building(check all that apply) I�ot# T 40 N R 09 E or w
�I or 2 Family Dwelling-Number ofBedrooms 3 2 Subdivision Name
Block#
❑Public/Commercial-Describe Use
� ❑City of
❑State Owned-Describe Use CSM Number ❑Village of
�,,�/30' �/�2S ❑Town of Bass Lake
� '���
III.Type of POWTS 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 System ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank �.jn-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and Date Issued
Expiration
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 .7 642 652 95.2-94.2
Capacity in Total #of Manufacturer
�
Tank lnformation Gallons Gallons Uniu � � v � ^
New Tanks Existing Tanks � o � � Y p � �
a U v� v, v� u.. C7 CL
Septic or Holding Tank 1000 1000 1 Wieser x
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POW7'S shown on t6e attached plans.
Plumber s Name(Print) Plum4er's Signature MP/MPRS Number Business Phone Number
Kelly Ferguson ' � , � 224069 715-416-4597
i l.. `t ; , "� ' ,�,
Plumber's Address(Street,Ciry,State,Zip Code)
W9502 Dock Lake Road Spooner WI 54801
VI.C u ty/Department Use Only
.'t Permit Fee Date Issued Issuing Agent Signature
�App ❑Disapproved �/� p ,/�� L
� ❑Owner Given Reason for Denial $ �O�•� �1� 'a"� '� I�t'�'r`�'P T'"""�"
Conditions of Approval/Reasons for Disapproval
� � � __.. F. .,,�a,.a...�,.�,._,..- ��_= �������
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Attac6 to complete plans for the system and submit to t6e County only on paper not less than 8 In x 11 mcties�in s�ze -'�" ` ` ,����
SBD-6398(R.02/22) NO R�FJNDS AFTER
ISSUE OF F�EFi1l��7
PRIVATE SEWAGE SYSTEM PLAN INDEX PAGE
Owner's Name: Kevin Scherz
Owner's Address: PO Box 445
Hayward WI 54843
Site Address:
Parcel ID: 57-002-2-40-09-07-5-OS-002-000090
Legal Description: S 07 T 40 N R 09 W
Subdivision Name: Lot No. 2 Block
Town of: Bass Lake
County of: Sawyer
Page 1 Plot Plan and System Sizing
Page 2 Plan View and Cross Section
Page 3 SBD-8330
Page 4 SBD-8330 Continued
Page 5 SBD-8330 Continued
Page 6 Septic System Maintenance Agreement
Piumber Name: Kelly Ferguson #224069
Plumber Address: W9502 Dock Lake Road
Spooner WI 54801
Telephone: (715)416-4597
Signature: ����'� � ��`����'/�
Date: 1/31/2023
_G.,�,��� � Co�, , ►V�q►�uGl v�-r. �� 1 Nl�y a�-�-`1 >
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Site Plan
Page_ �of
Owner:����.2, Dan Harrington CST#248357
11 /� �B—_�ed eleva�0.00
Date:�• y`,[o�
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Septic Tank(s)ManufacWrer.
IN-GROUND GRAVITY DISPERSAL AREA � ��� ��./ �/L���
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s);
3-ft Trench (down-sizing credit) � oc�, ga� ga� gal
,��ftlu�t Filter Manufacturer.
,% o Y_/<a c-
i �o? s'
Eftluent Flller Model#:
min.12"
SOIL COVER «dc��
12"
min,Vench
depth
caa���� �� •�' TYPICAL TRENCH
• • , • ��•• '''a�•a CROSS SECTION VIEW
��ryP4`�� . .° .. . f. (No Scale)
Ical ^�• ,
e .I n,• • a e
. �2 Cy,�_,� Provide minimum 3 ft
System Elevation= nL� —ft� separatfon between trenches.
(rypical)
Quick4 Standard-W
w/End Cap obse"'�'°"� TYpICAL TRENCH
(typical) (Show locatfon of inlet/outiet pipe connection on plan view.) �nstan Petym nuieccurers PLAN VIEW
'"�`"�"°"s, (No Scale)
(,r i r t �: — — _ �� � ._. _ _ _ _ ._ �� _ — — �7 t� i ��� r r �
�,��' 6V'��dptr�+.l�N+�'r�'a!K# ,/:Ra�.lA�f�t��4�'�r+k' Q'd�S��, � _0
�� ;�� ,i.ro�� E �� il) �I,I I�!��� �., ,I'i t�� I��i�:�� � �Gd,,��� CI(�t,� � A=3AR
( w�;���!H±i e�n�'�s k�a��`ia3��a�•�d' — — — — ��— — — — — — — — �� — — — '�i�e{.�u Y,_�'�c�a,�_�a�b H�b P1?l:�'�j ��YP��) �
B = � rt _� r�n
(typlcai) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typtcal) �
(mfd by Inflilrator Systems,Inc.) —n
Install pursuant to manufacturer's instruclbns. �
�Quick4 Std-W @ 20 ft2 EISA/chamber= ��Q ft2 ,
+ �,_ Pairs of end caps @ 6 ft�EISA/pair= � ft' .
= Proposed EISA per trench= _���h' ftz Required in�itration Area= �-3 ft' Distribution Method:
x .� trenches = Proposed Total EISA= ��� ft= /�-�'�.�� .� ��
., RESET,. ;
PAGE 4 OF 4
In-ground Gravity Management Plan
innPORTa�f:
� The owner of thls in-ground gravity system shall be responsibte fior its perpetua!operation and maintenance pursuant to
requirements of SPS 382-384,�sc.Admin.Code. Pursuant to SPS 383,52{2),Wisc.Admin.Code,this system shall
be considered a human heatth hazard if not maintained in accordance with this approved management plan.
Furthermore,ail inspection and maintenance activi6es shall be performed by a registered POWTS Mairrtainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dis4ersai Area Ooeratina Limits:
Design Fiow= �� gpd; BODS<_220 mgL''; TSS<_'154 mgL''; FOG 5 30 mgL''
Inspection Checkiist 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.,teaks, breaks, corrosion, etc.)
o �lids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distribution l�drop boxes}
o neglect or improper use(i.e.,exceeding design capaci�es,prohibited activities, efc.)
o extent of ponding in distribudon cell prior to dasing
o dosing i�regularities-if applicable(i,e.,pump re-cycling,float switch settings,etc.)
� o electrical cflmponents-ifi appticable(i.e.,wiring,connections, switches,controts,timers,alarms,etc_)
o distribution}atera!or tateral orifice plugging (measure tateral distal pressura—compare to design specification)
o surFace discharge of efNuerrt or sewage back-up into structure served
Maintenance Checktist MAINTAIN EVERY 3 YEARS (or when necessary)
o S@�tic and dose tank(sl shal!be pumped by a certfied septage servicing operator licensed under s. 281.48 W is.
Stats.when the votu e of salids in the tank{s)exceeds one-third(9/3)the iiquid volume of the tank{s)or
as rsquired by locst o�ance. Dispasal of contents shatl be pursuant#o NR 913,Wisc.Admin. Code.
o �ffluent filter,�si shall be inspected every 3 years and shalt be cleaned when necessary to remove any
accumulated solids according to manufac�turers spec�cations. A servicing period will always be greater than 12
months.
System mairrtenance reports shatt be submitted to fhe proper 1oca1 govemmerrt unit in accordance with
SPS 383.55 Wisc.Admin.Code. Report any component failure or malfunction to:
Name of individual ar company:.�_rr r�� , l�s'�. ,�ca ��.... Phone:�__�-������g 9
Locat govemmentunit ���., r ���-,,,�_, �9�" ,,,, r Phone:�S �3�/—�..,2�''$�
Local govemment unit address: ✓' ' 'O �'J{�', j',� ,�5=�,�r�_�y, j,v�,�„/ ZIP:�yrf'"� �'
Any defective part of this system shall be repaired,replaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code. Repair or rep{acement of failed or malfuncduning campor�ents 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.
Continaencv Pfan
In the event that any failed treatment component of this POWTS cannot be�epaired, it shatl be replaced pursuant to
a plan submitted ta the appropriate agency for review and approval. A failed in-ground dispe�sal component may be
abandoned and replaced by a code-complying dispersat component in a pre-deterrnined area of suitabte soils.
Svstem Abandonment
If use of this POWfS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wsc.Admin.Code.