HomeMy WebLinkAbout008-937-01-4109-SAN-2023-007 " County
Department of Safety �
. ' � & Professional Services, �
S' - Sanitary Permit Number(to be filled in by Co.) Z
= Industry Services Division
�3� ���
State Transaction Number �
Sanitary Permit Application _ 1
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is rcquircd prior to obtaining a sanitary permit.Notc:Application forms for statc-owned POWTS are submittcd to Projcct Address(if different than mailing addro
the Department of Safety and Professional Services.Personal infortnation you provide may be used for secondary
pu�poses in accordance with the Privacy Law,s. 15.04(1)(m),Sta[s. �00(��►�Lk �� ���7��/w ,_;
I.Application Information-Please Print All Infarmallon �L I
Property Owncr's Namc Parccl#
n ao�q:��or�y -Y(d`�
' a � Ca� e,h
Property Owner's Mailing Address Property Location
rN
Gbot.Ee!
City,State Zip Coc1c Phone Number
� O � r ��_'/.,_�'/<, Section __�
Il.Type of Building(check all that apply) Lot# T__3 7 N R E or
�I or 2 Family Dwelting-Number ofBedrooms � � Subdivision Name
�� Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use�� CSM Number ?J$(03 ❑Village of _
'�..�,�7� �aT��,�t' EDG��//�T E j�
ItI.Type of POWTS Permit:(Check either KNew"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.
�' �New S stem
y ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreahnent Unit(explain)
B' ❑ f{olding Tank �In-Ground ❑ At-Grade gn yp ( p )
❑ Mound ❑ Individual Site Desi ❑Other T e ex lain
(conventional)
C. ❑ Re�ision ❑ Changc of Plumhcr .�st Previous Pennit Number and Date Issued
❑ Renewal Before ❑ Transfer to New Owner
Expiration
IV.DispersaUTreatment Area and Tank Informallon:
Design Flow(gpd) Design Soil Application Rate(gpcUst) Dispersal Area Required(s� Dispersal Area Proposed(s}) System Elevation
y5o . 75c� 75� �17.4f'
Capacity in Total #of Manufacturcr
�
Tank Tnformation Gallons Gallons Units p � U � '�
U N V]
New Tanks Existing Tanks � o � y� � A � �y
a. U v� ,� in i,.. C7 0.,
Septic or Holding Tank ��
1 Oo �
Dosing Chambcr � __ ��
V.Responsibility St9tement- I,the undersigaed,assume responsibility for instsllatioa of t6e POWTS shown on the attaehed plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
�'�GtV� � 'L C
Plumbcr's Address(Strcct,Ciry,State,Zip Codc)
d D
VI.Cou y/Department Use Only
.1 Pertnit Fee Date Issued Issuing Agent Signature
�Appro ❑Disapproved ,� p� j�,,
�� ❑Owner Given Reason for Denial $ ��'� �` I� I�"� ����•eX�-�I I G�'1/L��
Conditions df Approval/Reasons for Disapproval � �,����"�'1�5'�S�r'�rr—r.,��
!� �'�, ,�,M,�„�,.,.....s,_.. ��`,---
f•^ ¢..�: j.. _ _... ..
� �� _..�- S �t �M1,
�
� ��GI�� � a � , � � �:.�� >>
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;,.i r td �a � �
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�c. ��. . �,..„ , -,� `;;y
Attach to complete plans for t6e system and submit to the Counfy only on paper not less than 8�R x 11 inc6es tn size �_
�� V ' �
SBD-6398(R.03/22) NO REFJhDS AFTER
ISSUC OF PEF���
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soiil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): Scott and Mhsty Couch Phone: 715 _760 _1939
Owner Address: 1376 134th Ave New Richmond, WI Z�P; 54017
Project Address: 14569W Wooddale Rd Exeland, WI 54835
Govt. Lot: NE �.1/4 of SE �1/4, Section � , T 37 N-R 9 E ❑or W❑✓
Township: Edgewater County: Sawyer
Project Parcel ID#: 008937014101
Designer Information
Designer Name: Kurt Brown Phone: 715 _943 _2988
Designer Address: W10487 Old Murry Rd Exeland, WI Z�P: 54835
E-mail: brownk@bevcomm.r�et > �t. � _ .
License Number: 224281
Remarks:
Signature: 1— Date: 1-23-23
Origin I signature required on each submitted copy.
Pnc�e z oF 5
SCOTT AND MISTY COUCH
1376 134THAVE
NEW RICHMOND,WI 54077
NE,SE, S1,T37N,R9W
TOWN OF EDGEWATER
WOODDALE RD
� ELEVATIONS
BM=100.0', NAIL IN 15"DIA OAK TREE
N 11"ABOVE GRADE.
SCALE: 1"=60' &1 =99.9'
�� B-2=99.4'
&3=99.1'
PROPOSED SYSTEM El.=97.8'
HEADER=98.3'
PUMP EL.=-92.3'
DIFFERENCE=6'
SIZING INFORMATION
DR.WAY DESIGN FLOW=450 GPD
SOIL LOADING RATE_.6 GPD/SQ.Ff.
ABSORPTION AREA REQUIRED=750 SQ.FT.
2-6 X 63 Ff.AGGREGATE TRENCHES TO BE
INSTALLED.
SIGNED- I'�-�
224281
PROPERTY CONTAINS 5.02 ACRES. IT
IS COMPLETELY UNDEVELOPEDAS OF
11-30-22.
�>10%
98.4' ---_"_' -.� B-3
�99.1'
❑
99.4'-_„-.� -'" �B-2
�&� 99.4'
BM
� 99.9'
100.0'
2"FORCEMAIN� . FUTURE
CABIN
1,000/600 GAL.
COMB.TANK
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Washed Aggregate
SOIL COVER
0.5'TO 2.5'WASHED AGGREGATE � 4"�
�ao,ex,;,e PertoratadLateral m'° 1z' TYPICAL TRENCH
(min.6.0"beneathdishibutionpipe Cover � (typical) HP���)
-min.2.0"overdistributionpipeand � ROSS SECTION VIEW
covered with approved synthetic fabnc) �I . (No Scale)
12"
min.trench � � s �
depih L _ ^
(�YPical) . �� , . .
Provide minimum 3 ft System Elevation�7•8 ft. � �`�;���� OBSERVATIO SP�PE DETAIL
separation between trenches. (rypicaq s��ew-TYPao� •
SlipCap�loase) �"'.d FinishetlGratle
(mulchetl 8 seatlea�
4'OPVCPIpa �;.� TopsoilCover
Tap af pipe to tertninate (min.1 foot)
a�o�above finishetl g ratle
(Show location of inlet!outlet pipe connection on plan view.) �a�va^-iiz^x e^sm�s
TYPICAL TRENCH @�b apart
PLAN VIEW A��ho��9oe���e �������a,�o�
s�na�
(No Scale) 4 �
Perforated Lateral
(typiCal) Observation Pi ft
Pe
� (center lateral in trench) (typical) (typical) �
i I i
� - - - �
�� — — — — — — — — — — — — — — — �
r - - - - - - - - - - �
i --------------------------------------�----------�-----------�-- i A = 6 n m
�- - - - -�- - - - - - - - - - - -�� - - - - - - - - - - - - - - - - - - - - J — (�'Picaq W
i= B = 63 ft =i Q
(tyP��p �'I
C31
Distribution Method:
Required Infiltration Area = 750 tc' branched manifold �
Proposed Total Infiltration Area = 378 n'per trench x 2 ;;�^�"�� = 756 n�
RESET. :
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vent Pipe
>10 ft from
Builtling ElecMcal must mmply wi�h
'17'Min.or20flabove SP5376andNEC300
EstaMishe.d Flood Flevalion Ex�ena manhole nser as necassary.
(rypi�l) Weatherproof
Appmved .lunclion Box
Vent Cap APP���Lockirg Manhole
IMPORTANTf �with Waming Label Altached
Anchor tank(s)as necessary �ry���
pursuant to SPS 383.43(8)(g) —condui�
4"Min.or 2 0 ft ahave
Fslablished Flood Elevation
(rypical)
�AiNghl Seal
Finished GraAe 1
Quick�isconnec� I
18"Min.
CAPACITIES @ 16.47 ga�/i� y �ryP���>
Depth(in) Volume (gal) I a �
A 18.6 306.34 'r�
Weep ��Approvetl JaiNs with
Hole Appmvetl Pipe 3 fi onto
B 2.0 32.94 n � sare����d
� prP��q
[C] 6.4 105.4
_Alartn
D 12 197.64 B �—o�
� [c] PUMP-OFF
*Pump Tank Liquid Level = 39 in —r PumP �—Of' ELEVATION = 92�3 ft
I
° INSIDE BOTTOM
Force Main Diameter = 2 in c°""�'e
B�°�k ELEVATION = 91�3 ft
Force Main Length = 95 (t 3"ApprovedBeddingMatenal8enealhTank
Force Main Void Volume = 15.4 gal
[C] Total Dose Volume TDV = 105.4 gal/dose
��
(<02X design flow+force main void volume)
Vertical Lift = 6 ft
PUMP TANK: SEPTIC TANK(S):
Volume = 642.33 gal Total Volume = 1,000 gal
Manufacture kaw Precast Manufacturer(s w Precast
Pump Manufacturer: Zoeller
Install approved effluent filter at the septic tank outlet
Pump Model: 53 ��a„a�,�P�mPq1Ne.� immediately upstream of the oump tank inlet
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Lifetime
Controls/Alarm Model: Tank Alert - 1 ��8
Filter Model:
Float switches containinq mercury are prohibited.
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PAGE�OF s
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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 shail be performed by a registered POWTS Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= 450 ypd; 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,e[c.)
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,e[c.)
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(sl 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(1l3)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(s1 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:BfOWII�S EXC2V8t1119 Phone: 715 943 2390
�o�ai 9o�e��me�c�n�t: Sawyer County Sanitary and Zoning Phone:715 634 8288
�ocal government unit address: 10610 Malrl St#49 Hayward,WI Z�p 54843
Any defective part of this system shall be repaired,repfaced,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.
Contingencv 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.