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Home My WebLink About010-841-29-3105-SAN-2023-017 �� 1�=��'-"��;� [ndustry°Sen�ices Division County � �_-: `-; � 7 I�3 4822 Madison Yards Way SaWyef Z �; ti SP - I � Madison,WI 53705 Sanitary Permit Number(to be filled in by Cc � a '1 l P.o.Bo��3oz , 1 R� — f� �� Madison.WI 53707 � J�� \ !\,5� ` ,�`r w "�(��'t\ Sanita� PeY,l,Y.lit AppllCatl�n State Transaction Nu��ber \ In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn ro the appropriate govermnental unit � is required prior to obtaining a sanitary pennit.Note:Application forms for state-owned POW7'S are submitted to Project Address(if different than mailing addi � the Department ot�Safcty and Professional Scn�ices.Personal inR�nnation you provide may be used for secondary purposes in accordance with the Privacy La��,s. 15.04(1)(in),Stats_ �;�� ,�, (��5� I�i Y �!h ��v�. I.Application Information-Please Print All Information � � Property O�cncr's Name Parcel# THOMAS A & DEBRA L HARD 010-841-29-3105 Property O�cner's Mailing Address Propert� Location 15193 S HAEGELE RD �� City,State Zip Codc Phonc Number GORDON, WI 54838 !`� ��<, S`^� ��, se��r, 29 ll.Type of Building(check all that apply�) Lot# T 41 N K �$ E or W �l or2 Famil��D��clling-Nmnberof[3edrooms 2 � Subdivision Name �- Block# ❑Public/Commercial-llescribe Use � �Ciry of �State O�vned-Dcscribe Use CSM Nwnber �Village of 22/45 #6123 �T��t�� HAYWARD III.Type of POWTS Permit: (Check either"New"or"Replacement"and othcr applicable on line A. Check one boz on Iine 13.Complete line C if a licable.) A� New S stem Re lacement S stem Other Modification to 1?xislin S stem ex lam Additional Pretreatment iJnit ex lam ✓� Y � p Y � S�Y ( p" ) ❑ ( P ) �' �HoldingTank �ln-Ground �At-Grade �Mound ❑IndividualSiteDesign Other I�pe(c�plain) (conventional) ��• ❑Rene�val Before �Revision �Chan�e of Plumber �I ransfer to New Owner List Previous Pennit Number and Date Issued Expiration IV.DispersalfCreatment Area and Tank Information: Design Flo��(epd) Desien Soil Application Rate(gpd/st) Dispersal Area Rcquired(st) Dispersal Area Proposed(st) S��stem Elevation 300 0.7 429 452 ��{, �s Capaciry in Total #of Manufacturer Cank Information Gallons Gallons Units � � �o �„ o New Tanl:s F,�isting Tanks '� c � � � p � � 0 a U v� � v: u. C; n. Septic or Holding'I�nk 750 750 1 WIESER CONCRETE ✓ � Dosim�Chamber � � � V.Responsibility Statement- I,the undersigned,assume re onsibility for instal tion of the PON'TS shown on the attached plans. Plumber's Name(Print) Plumber's enature MP/MPRS Number E3usmess Phone Numhu _. , Travis Butterfield ,�,--� �_`�Y� �� 652879 715-634-8176 Plumber's Address(Street,Ciry.State,Zip Code) 14346W St. Rd. 77, Hayward, WI 54843 Vl.Counh'/Department Use Only �� Permit Pee Datc Issucd Issuing Agent Signaturc �Ap ro e ❑Disapproved $ J - - , �f�, � ❑Owner Given Reason for Denial YQQ,�� I`�( �3 � J��''�X�'"l ,G"�vv'��-- Conditions of Approval/Reasons for Disapproval ��'� A D � �J+�iT\`r t i z�.��;'�' �� I �� :;.�____��_� ��3 ...__..�._.. -�,;, � � �L � � , � ,S�' �-� —�I b .', '�.� �y�l s MAR 0 �_z�t�� . ',_.. , C � ` ..��r.,.�, � s�� SAW`��.�� • + {��' ZJt�fli`dGF��tir;i..�. Attach to comple[e plans for the system and submit to the Counh'onl}�on paper not less than 8 1/2 x 11 inches in size � IS11 sQ�-639s�R.ozizz� NO R�FJNDS AFTER 15aU�Ur PER'V11T ��►�� -� 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 Owner Name(s): THOMAS A & DEBRA L HARD Phone: - - Owner Address: 15193 S HAEGELE RD, GORDON, WI Zip; 54838 Project Address: PARCEL #010-841-29-3105 Govt. Lot: 1/4 of 1/4, Section 29 , T4� N-R 08 E❑or W ❑✓ Township: HAYWARD County: SAWYER Project Parcel ID #: 010-841-29-3105 Designer Information Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176 Designer Address: 14346W. ST. RD 77, HAYWARD Z�p: 54843 E-mail: OFFICE@BUTTERFIELDDRILLING.COM =l�t,is s��a«res�rved ro,-ap��i-o.��i� starii�. License Number: 652879 Remarks: Signature: Date: �3 � 2 Original signature required on each submitted copy. i . = � P`�>� :� �� YI ��.. �� ; � ��o��s �� -� s�w �.� . I ��°�� 5 ��►�c,� � `� , ��.��.�� Go a-C�oN, �S �3$ - �r�`. O�D .--S►�!._... °z.�..q 3 ( b S Y�i��s w ,� z.� 1 �t n� f� D� u./ ( 5j��e : d� �Gz;��e�..� �'t---- L.�-f�- L Cs�'1 z�.:r�ls � �[ z.� i d — �3�f+ I � I � ' ; � . I � � i . l � l a��i�� ^ _ , ....... �-�--- �-_. - r.w, �.-� �---, �_--_ � � � �� , � �-.. � �..' , Y ` �°� � � `� �- � � � � I � �.... � ; abt � �,�. � k I � � �f I � � � ��.5�' �J�'�W. ��crc� �v r � 0 ' � � � � �� .;�.� �% �l�s ( ��, � � � o � � � � � i�:�� (� . � : ,� � ; �. �y,�� v�� s i S�. s�� ,� � ; � � / �� ; � � -- - I ; - Lp��- �. I - - - ��,� �13!'L}�DO�I (1��nv� ��u� er� Ig`. . p�� .. S t, 9'?�u�` f r' ! QL •� , �. �`i`t:I� �.___.__ �'�r�� L;h � . 4�.�7` -`- -�"I .�;�s� S`c�s�. e.�. 4�.'�S" � t�c.�n.g e g 3`---- �5.�'` �"c�.�� ``:,�a' � � � - � LoGr-`bio��stz� o� ��a�s a.�� . � l0 3a �e �fo 5d -� �,�!e U --E� �,�`� S�b�5 ? ' ��\� � �� S� t.os Z�,�� ; `�i�w�-5 13 t�I"�Z��C� Septic Tank(s)Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s): 3-ft Trench (down-sizing credit) �5o gal gal gal gal Effluent Filter Manufacturer: BeSt � E�ue�t F�ite�nnodei#: Gf10-8 min.12" SOIL COVER (ryPlcal) �2,� min.trench depth criP��a�> <� TYPICAL TRENCH � � �°.a �. CROSS SECTION VIEW �,,p��a�> �:�a� � �" (No Scale) , a a . ` Provide minimum 3 ft System Elevation — 94.75 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap Observation Pipe TYPICAL TRENCH (Show location of inlet/ outlet pipe connection on plan view.) (rypical) (typical) Install per manufacturer's PLAN VIEW instructions. �NO SCB�e� � - - - - - �f- - - - - - - - �� - - - - - - - - - — � I � , • I �A= 3.0ft — (tYPical) � � - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - � D G� r- B = 44 fc -� rn (typical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typical) � (mfd by InfiltratorSystems,Inc.) � Install pursuant to manufacturers instructions. � 11 Quick4 Std-W @ 20 f� EISA/chamber= 220 ft2 + � Pairs of end caps @ 6 ft2 EISA/pair= 6 ftz = Proposed EISA per trench= 226 ftz Required Infiltration Area= 429 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 452 ft2 branched manifold � 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 Dispersal Area Operatinq Limits: Design Flow= 450 gpd; 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,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-cyding,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 tank(s)shall be pumped by a certified septage seroicing operator licensed under s.281.48 Wie,. 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: BUtt21'fleld, IIIC. Phone: 715-634-8176 Local government unit: S8Wy2f COUllty ZOnlll9 Phone: 715-634-8288 _ �oca�go�ernment unitaddress: 10610 Main St. Suite 49, Hayward, WI ZiP 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,Wisa 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. SYstem 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 co��ty ,�,.,; ; ,i r _ ; D � SYSTEMS Sawyer ,-,�SpS ! I � �_�,�;` ( POWTS) ' '"� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �3— Ol'� Personal infonnation 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#: �ow�as {�U��D'�zi Ka� Kw ac�+ ~ Insp BM Elev: BM Description: Parcel Tax No: tpo.o � ce.*^�,,.-� �' �w� �,�s-� o�o �8Y l—�9' - 3co.s' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,�Q 7� Benchmark �o�,,o� Dosing Aeration Bldg. Sewer c��S� Holding St/Ht Inlet y 6.Sg ' TANK SETBACK INFORMATION St/Ht outlet �'6�33 ' TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIRINTAKE Septic �� -,25-� �} � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. q S S- � � Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative �y s I Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N � L c(t,` #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �`) INFORMATION P/L Bldg Well Waters Q GP � Chamber Motlel Number: ❑ EZFIow CELL TO •} ' ` N ❑ Mound o Other � — S-- �'S"�_ �a - - _- -_ Y __ DISTRIBUTION SYSTEM X Pressure Systems Only Hea�der/Manifold -�istgbution Pipe(s) — - p I X Hole Size I XP oleg Observation Pipes I Len th Dia Len th Dia S ac S acm ❑Yes ❑ No SOIL COVER Depth Over Depth Over r Depth of Seeded/Sodded Mulched Cell Center Cell Edges �, Topsoit � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��1� � ja-o��3 Plan revision re uired?� Yes 0 No I c� ��_ _ � - l�� q oz �-S ' G� � (� L __� � � Use other side for additional information Date POWTS inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBEA:__�-a�1__ ��f j$" �- � �.�� 's�� `' �� '� � �. �.�e.. C��°� ,�� ,►�- , ��.� �— �� P � � 62 Q��(\d� � O� \+ � � � w�� • �� 7 � lN(� � \ S� o C� �- - �� I � �� ,5► �— — — —� � V"J,a-� �� QQzs c�` —pd-- � �'~,�` ,��-�,r� � �.l s -