HomeMy WebLinkAbout002-940-27-5202-SAN-2023-009 _ "'`� Department of Safety �°°"�' SAWYER �
_ � = & Professional Services, �' I
� . �� - Sanitary Permit Number(to be filled in by � ,
,,, �� � , Industry Services Division ,
�., . - Co3�'� 3 � 1 � �
Sanl+aj''�l PeY,j,nl* A llCatl�n State Transaction Numbcr �
�� J � pp NA
In accordance with SPS 383.21(2),VVis.Adm.Code,submission of this form to the appropriate govemmental unit O
is required prior to obtaining a sanitary permit.Note:Application forms for statc-owned POWTS are submitted to Project Address(if ditTerent than mailing a �
the Depariment of Saiety and Protcssional Services.Per,onal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. �15390 W TAMARACK TRAIL �
I.Application Information-Please Print All Information
Property Owner's Name Parcel#
AMY K. GRAVES 002-940-27-5202
Property Owner's Mailing Address Property Location
1457 CASCADE Govt.Lot 2&3
City,State Zip Code • Phone Number 27
BARRINGTON, IL �oo,o ��4. ��4� se���on
II.Type of Building(check all that apply) ,t �_ot# T 4� N R 09 1�or W
C�or�Family Dwelling-Number of Bedrooms `t 1-1 Subdivision Name
l3,ock a NA
❑Public/Commercial-De.scribe Use N�
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
#223; V2, P7 ���f BASS LAKE
IIL 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 xfteplacement System ❑ Other Modificatiun to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
�' ❑ Holding Tank In-Ground ❑ At-Grade g yp' p'
❑ Mound ❑ Individual Site Desi n ❑ Other T �1 ex l�in)
X(conventional)
C• ❑ Renewal Before ❑ Re�ision ❑ Change of Plumher ❑ Transfer to New Owner List re�ious Permit Number and Date Issued
Expiration �b-�b� ��y �6
IV.DispersaUTreatment Area and Tank Information:
Design�l�ow�(gpd) Design Soil�Application Rate(�*�d/stl Dispersal Area Reyuired(s� Dispersal Area Proposed(s� System 6'levation
�� 857.15 900 97.00 FT.
Capacity in Total #of Manufacturer
7�ank Infonnation Gallons Gailons Units � � v „ � � �
New Tanks Existing Tanks y o � L � � = �
a. U �n �; v: ii C: f�.
Septic or Holding Tank 1 20� 12�1/ 1 WIESER COMB A
Dosing Chamber $U� 800
V.Responsibility Statement- 1,the undersigned,assume responsibility for instaliation of the POWTS shown on the attached plans.
Plumber's Name(Print) Pimnbe ignature MP/MPRS Number Business Phone Nambcr
l ' � � ' jQ/ �!5 5���(%3
Plumber's ddress(Street,City,State,'Lip Code)
U�1� /v ��r�.�l-y����P �l�- ��� �r u� � �� .����'���
VI.Cou ty/Department Use Only
�Ap d ❑Disapproved germit Eee Date lssued Issuing A�;ent Signature
❑Owner Given Reason for Denial �C/��� �`� I a 3 ��""""""��� r��'"'��`-�;,.
Conditions of Approval/Reasons for Disapproval ' �':'t;',-j;��J�^`�___'i,l _�(�=�`j ';,
��
� �� .
� � �,�k�_��- a 3 �.T,��..,...�. F�B 0 1 2�23
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�7 '�k# .���--�---�-- �p`,�YER LOUNTY
C S� �J� O v� ,.��' (�J PA���t� �� � ZONING ADMINISTRATIO�
,:; , �� � 4F
Attach to complete plans for the syslem and submit lu the County onl�on paper not less than 8 Irz x ll inches in size '
3� S�
ssD-�39R�R.o3i2z> NO R�FJhDS AFfER
ISSUE OF PERtY►iT
PAGE 1 O�5
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Component Marual Design References:
In-Ground Soil Absorption for F'OVVTS Version 2.1 (AAay 2022-2027)
�� 9 ��� Index�Cover Shee4
I������ � Plot F6an
��3��� DispeTsal Area Cross-Section�Plan Vievv
�'����� Pum��Tank Specificatio�as
�� ���� Mana�ement Plan
�@8��9�eea�e�ts: �n�;fi�sa����a
Pump Curve PO`�S Application for Revievu
Soiu Evalua4ion Report&Site Map
'j71� STAtEMF/V7
�������9�eo��/�scri�46��
Ow+ce��Pdarr��s): �4nAY 9C.C�RE�.VES �����; - -
�y����,�g����: 9457 C,4SCADE, �AR'a9NGTON, IL �;�; 60010
Projec4 c�d�reaa: 15390V1/T,4flflAF�CK I��IL, HAYWP�RD
i8ov8.Lo4: 2$3 1/4 of 1/4,:�cction 27 ,T �� IV-R 09 E�or W❑d
T��rnahep: 668SS LPeE(E C�usaB�+: SAWVER
�aoj�c¢6�arc�B I�86: 002-940-27-52J�
��og�es��Om���ego�ta�a�
Design�r R�aeg►e: ����JO�IU�PERT ��y�w�_ 715 _426 e 1775
p��s������r��$: 25720 FIFtEFLY LAi�!�,VVE�ST�F2,VV9 ��; 54893
���aB° hollisterdesign@outlook.com :�� .... ��`�"�''•y,
,,.
�6��nse�Iuev��P: 1859-007 �:= .
��ena�tt�: `y� •E„-! - ' �.
_ *+ --, �
� •�:;'._....._�.. -
ABANDON OLD SYSTEM PER SPS 383.88 WIS.ADM.CODE =� j;;"
�'� ` .
g��'''�., . �;�•1� • .e� ,�c'
'••:.�;:•. : ` '
—� �:.,:,�::�;:.....,:.
�i��a���a��: ' f,G� � � �! Date: 01 -30, 2023
signatUre requi eaCh tiuhmitled copy.
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
� � �
I min. 12"
ce°�eXt'� I I ctiP��o TYPICAL TRENCH
cover
SOILCOVER CROSS SECTION VIEW
��• � (No Scale) OBSERVATION PIPE DETAIL
min.Vench � e � (No Scale)
depth
�ryP���� L — r - - � Screw-Typeor FinisheCGrada
SAp Cap(loose) "` (mulchetl&seadeC)
!f e ,
S stem Elevation/J�'oo ft. + +' 4'9PVCPipe TopwilCover
y ' Provideminimum3ft Topofppetotertninate (min.lfooq
�ryPIC2�� at or eEave(inished g2tle
separation between trenches.
�a)i�a^-i r�°x e^sb�
@sb aPen
TYPI CAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) n��,o��9 oa�� i�nn���
s�ne�
PLAN VIEW -
(No Scale) 4„� pbservationpipes�allbeinstaMetl
at junction 6atvrean two unih. �Q n
Perforated Lateral Observation Pipe
��YPical) (ryp;�i) lryaicap
r - - - - - - - - - - - - - - ��- - - - - - - - - - - - - - - - - - - -
______:_ �
_-__: __ ___ _______ — D
I =__==_ ______= A — 3.0 ft
� - - - - - - - - - - - - - - - �s- - - - - - - - - - - - - - - - - - - - J �ry��n G�
�. B = �0 n �; m
cry��n w
INSTALL PER TRENCH: 60o GPD / 0.7 LR = 857.15 FT 2 EZ1203H eundle �
50 EISA/UNIT = 17.15 OR 18 UNITS X (typical) T
� 10-ft bundles @ 50 fl� EISA/unit= 450 ft,10 FT. = 180 FT. /2 = 90 FT. �mfd by�nti�tratw Systems, Inc.) �
(2) 3 FT. X 90 FT. TREN���ursuant to manutacturers instructions.
+ 5-ft bundles @ 25 fl� EISA/unit= ft�
= Proposed EISA per trench = ��� ft' Required Infiltration Area= 857.15 g� Distribution Method:
x z trenches = Proposed Total EISA = ��� ft= branched manifold �
GRAVES, AMY K.
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4'0 Vent Pipe
>10 fl hom
Builtling ElecUical mus�compty wilh
17 Min.or 2.0 ft above SPS 316 and NEC 300
Eslablished FIooC Elevalion W��M1e�� Exlend manhole riser as necessary.
(ryP���) Junclion Box
A�r�� Appmvetl Locking Menhole
IMPORTANT: va"��P with Waming Lahel Allached
Anchor tank(s)as necessary �ryP���
pursuant to SPS 383.43(8)(g) cora��t 4•Min.w 2.0 fl above
Eslablished Flootl Elevalion
(ba��0
�Airtight Seal
Finished G�ade 1
_ �uick Disconned I
78'Min.
CAPACITIES @ 22•24 gaUn y . �hP��'>
Depth(in) Vo I) • � I
A 21.0 467.04 — 'k�
I Weep ��ApprovedJoinlswith
Hole Apqoved Pipe 3 ft onta
B 2.0 4Q.48 q Sdid Ground
� I Moi�q
[C) 5.0 111.20
Alartn
D 8.0 177.92 -B�� �_o�
� [c] PUMP-OFF
�' 36 � PumP —Off ELEVATION = $5.67 f(
Pump Tank Liquid Level = in �
° INSIDE BOTTOM
Force Main Diameter = 2 in �°"°'�'e
B��* ELEVATION = $5.00 ft
Force Main Length = 49 ft 3�'�f°��ing Ma�enal Bene9th Tank
4(J FT. X .163 GALS = 7.99 FLOW BACK
Force Main Void Volume = � y� gal
i I 1.20 - 7.99 = 103.21 GALS PER DOSE
(C] Total Dose Volume TDV = 111.20 gal/dose
(<02Xdesignnow+torcemainvoidvol 49 FT. X 1.39/100 FT. = 0.68 FRICTION FACTOR
97.00 FT. SE - 85.67 - 11.33 + 0.68 = 12.01 TDH
12.01
Vertical Lift = ft
PUMP TANK: SEPTIC TANK(S):
Volume = 800 gal Total Volume = 1200 gal
Manufacture WIESER Manufacturer(s): WIESER
Pump Manufacturer: ZOELLER
Install approved effluent filter at the septic tank outlet
PumpModel: 98 ��a��,�p�mP�,,,,e� immediatelyuostreamoftheoumotankinlet.
Controls/Alarm Manufacturer: SJE RHOMBUS Filter Manufacturer: ORENCO
Controls/Alarm Model: AB TANK ALERT
Filter Model: 26
Float switches containing mercury are orohibited.
PAGE50F5
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosedyravity 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 'rf not maintained in accordance with this approved management
plan. Furthermore, all inspedion and maintenance activities shalt be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area O�eretina Llmits:
Design Flow= 600 9Pd; BODS 5 220 mgL"'; TSS 5150 mgL''; FOG 5 30 mgL"'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance fadors(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 vdume in anaerobic treatrnent 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, Gmers, 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 Seotic and dose tanklsl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats.whe�the volume of solids in the tank(s)exceeds one-third (1/3)the Ifquid 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 deaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servidng period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local govemment unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
P Y ��,�—�1 i 'r" "K �7 _ ,' -��
Name of individual or com an 1(.i"� Phone: / �� —S�� I�� �
�oca� 9overnment unit: SAWYER COUNTY ZONING pnone: 715 - 634 - 8288
Local govemment unit address: HAYWARD, W I 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.
Contin4encv Pla�
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 POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc.Admin. Code.
Piot Plan � ��,�
�
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PROPERTY OWNER: ��titY K. ����5 1" _= 40 FT.
(exceptwhere noted)
legal Description: �Kf. G�F C=��T, (�s�s Z�-�, pel ,� , <�;.'ol-# LZ3. �Z, PZ_ �] = backhoe pit
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COiVS�LT �-r.0 i ORY FO� SPE�IAL APPLICATlC��t`�
Elearid alEemators. tor duplea sys�ems, are avaBalile ar�d • varfable lerei tbet�es are availe�le ror cantroPn9 srgle
suppiied wMh�afarm. and tlxee Phase sysUer►�s•
�����dupleX SysOems• �'e availaWe • p�Wy9ypsdc varieple Ievel float swftches are availaWe
wiUi w wilho�A alarm switrhes- fof Veriable level lon9 cYde contrDlS.
c_L2C710N GIJIDc
1. trMe¢d mM Wmaletl 2 Oda�r�SwiMJ4 ro axYmv owWd�aG�. v:.
Standard ali models -Wei ht 39 ibs. - '/ H.?. Z ginyepqpybskwi�ab.demts�.YMa'do'N°aQm'b°d"'ai°a°�'
98 Sw� Ca�InM eaYttlm bYl srid�itMs b FAIO�T/. .
yoaN Volls-Ph Yod� A s 3 MW�vivl�nebr 10-OU72 ar 10-0075.
MBB t 15 1 Aub 0.� t or t d 7 d. Ses FM0712.br cornU modd o/Elecbiral AYr��.
1 COrto��wNd�10-0?�S uMd p a m+6d�c4wbr.cp�eiY d�(3)w NI
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oee z3o i wo �.� i a.i a� — a wr M nae.�rrc.i�+��ro�.�rcw c���cao^«w.ea+�
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7. rwo(2)nde 1FaR.wr wa�er49��a,nnac9on or sw�rz.
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����fl�������,� recm:Y.atlonal Eleclric Cotle(�IEC)anc 11�e Occwalbnal5ateq ami Heaqh�kl I�NAL
e'i.:: � -'YeW� "t..�V¢t`�`�.�''�v .� _. v.d. .
For urxisual conditions a reserve safety fac�r is engneered mtn the design of every Zoeller pump.
.__ —___—.—_. _ _ ..__ �MI.TQPO.BQ1fImQ .__ '
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PUMP !O. '�''����
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-��'"�""-'-�"�`%:,; PRIVATE ONSITE WASTE TREATMENT county
�z>� ,
-' o = SYSTEMS
�SP$ ' ( POWTS) Sawyer
�� ,�,
��`° � �� INSPECTION REPORT Sanitary Permit No:
,,�
Safety and Bwidings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 3 —'��4
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)]
Permit Holder's Name: ❑City ❑ Village l� Town of: State Plan Transaction ID#:
� ISI�v`4-/ �ctSS l�w� �_
Insp BM Elev: BM Description: Parcel Tax No:
(o�.o� C���. ��-s�d�� ye.�,,�,�� oa� -4Yo-a7- S��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic „„i�s — ��jo Benchmark ioo A`
Dosing r-�ar•�o 8?�
Aeration Bldg. Sewer "i I•� �
Holding St/Ht Inlet �c�,$ �
TANK SETBACK INFORMATION St I Ht Outlet 9'0•6'
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic ��o� r,ts` �9 �F-1`t` NA Dt Bottom b�•S
Dosing " " " '" NA Installation
Contour
Aeration NA Header/Man. `�g.d `
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative �,v �
Surface
Manufacturer �y�l� Demand Final Grade
Model Number �� GPM
TDH (D Lift Friction Loss Sys Head TDH Ft
Forcemain L 3�p ` Dia r2�` Dist.To Well
DISPERSAL CELL INFORM TION
DIMENSIONS W L $g� $$ #of Cells Type of System Distribution Media Manufacturer'
SETBACK OHWM of Nav 1� Conv ❑ Aggregate �� l ,
INFORMATION P/L Bldg Well Waters � IGP � Chamber
❑ AG o EZFIow Model Number:
CELL TO fi �v' *I O �-�' •}-�j ❑ Mound o Other Q�,�.
-- -_----- — -_-----
- — _----- — --
DISTRIBUTION SYSTEM X Pressure Systems Only
Hea�der/Manifoltl Distgbution Pipe(s) — p -I X Hole Size— XP ole9 Observation Pipes ;
Len th Dia Len th Dia S ac S acin ❑Yes ❑ No �
SOIL COVER
---- - -
Depth Over Depth 9ver � Depth of Seeded I Sodded � Mulched �
Cell Center Cell Ed es To soil _ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
�,��G� i 2 I y f a 3
Plan revision required?� Yes❑ No ��p � ��� �
2 �7 y � ,
� l—_J �— �?�-�- � _� � S�1�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER: 23— O��
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