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HomeMy WebLinkAbout012-640-17-2116-SAN-2023-052 Department of Safety c°°nty ��' � & Professional Services, � $ Sanitary rtnit Number(to be filled in by Z Pa � Industry Services Division �3"I 3 � 1 � State Transaction Number � Sanitary Permit Application '� [n accordance with SPS 383.21(2),Wis.Adm Code,submission of this form to the appropriate governmental�mit Q is required prior to obtaining a sanitary permit.Note:Application forms£or state-0wned POWTS aze submitted to Project Address(if different than mailing a� � the Depariment of Safety and Professional Services.Personal information you provide may be used for secondary purposes in acwrdance with the Privacy Law,s.15.04(l)(m),5��5. U 4 H Fs o R EI.�Y R D � I.Application Information-Please Print All Information H �' PropeRy Owner's Name Parccl# 0 Property Owner's Mailing Address Property Location 7 Govt.Lot City,State Zip Code Phone Number F� �� ��_'h,�w '/4, Section �I__ Q.Type of Building(check all that apply) Lot# � T_� _N R E or� �1 or 2 Family Dwelling-Number ofBedrooms '3 Subdivision Name �+ Block# ❑Public/Commercial-Describe Use s� --- ❑City of ❑State Owned-DescribeUse N� CSM Number �.t', ❑Village of �� 33�ZZ3 *��j �Townof �-Lh'�er III.Type of POWTS Permit:(Check either"New"or KReplacement"and other applicable on line A. Check one box on line B.Complete line C it a licable.) A. �New System ❑ Replacement System ❑ Other Moclitication to Existing System(explain) U Additional Pretreatme�t Unit(explain) B' ❑ Holding Tank �In-Ground ❑ At-Grade gn yp ( p ) ❑ Mound ❑ Individual Site Desi ❑ O[het T e ex lain (comentional) �'• ❑ Renewal Before ❑ Change of Plumber ❑ Transfer to New Owner '��t Previous Permit Number and Date Issued ❑ Revision k:xpiration ...--i- iV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Applicatio ate(gpcUs� Dispersal Area Required(stl Dispersal Arca Proposed(s� System Elevation �t('S0 . 5 qD0 94'y �O. ' Capacity in Total li of Manufacturer Tank Information Gallons Gallons Units � o U �, � � New Tanks Existing 1'anks F o c; � � Q � ro w U in ti in w (7 0.� Septic or Holding Tank �,� ' � x Dusing Chxmber V.ReSponSibility Statement- I,the undersigned,assume responsibility for installaHon of the POWTS shown oa the attached plans. Plumber's Name(Print) Plumber's Si�mature MP/MPRS Number Business Phone Number A'� � 9W � Plumber's Address(Strcet,City,State,Zip Code) d VI.County/Department Use Only � Permit Fee Date Issued Issuing Agent Signa[ure ��� ❑Disapproved ❑Owner Given Reason for Denial $ `�a���� 5 � I I � �3 "��u.���-f�=�- Conditions of Approval/Reasons for Disapproval � 3 � .�__ ° � �����;� � �� ��� - s „ � _ --�-- � ��ate � � `��: , �hk# ���� ��. MAY 1 1 2023 ;- � C �� q L �J � I " 'I�) ''"'����--�7 SAWYER COUi'�"�Y �'� � DMINISTRATIOPI.. Attach to complete plans for the system and�ubmit to the Couoty only on paper not less than 8 tn z 11 inches in size �-i I�i"13 SBD-6398(R.03/22) NO REFUNDS AFTER I�SUE OF PERlVI�T 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(sj: Lena Land LLC Phone: - - Owner Address: 754 Glenwood Drive Fon Du Lac, WI Z;p: 54935 Project Address: 9119N Fiorelli Rd Hayward, WI 54843 Govt. Lot: NE �1/4 of NW �1/4, Section �7 , T 40 N-R 6 E Q or W ❑✓ Township: Hunter County: Sawyer Project Parcel ID #: 012640172116 Designer Information Designer Name: Kurt Brown Phone: 715 _943 _2988 Designer Address: W10487 Old Murry Rd Exeland, WI Zip: 54835 E-mail: brownk@bevcomm.net _ License Number: 224281 Remarks: Signature: Date: 5/9/23 ri nal signature required on each submitted copy. __ _ _ —�'`"�� � ' � f -, �`�� c: '�_�^�` � �, i � �} j?�'iu-:&� r f!i i,`«:i�� �.� --�"' ..i� .� . . i . . . . . ��' � � j " f , ..:/f j f`r�` ' �._��--� � _ � _»--�___�_ �, � )�'L` '._.-,,--.a,. _._�------� ""'...-----._. �w- `-------�._._ �� %.��� ��� '"'�'�"'�""'"@� i �?�tCi 1 ` SIZ11.1G , ��If,o � � ��-�>�-' ---�— ' � � ��s��-�1-�'W�1 = �i 5t� G�� ; ;� soi�. i.v�+.�aS NG [2 aT� � .� �POlSa.s� ; _ A$SO�2 PT��N AR,E� ���txt RE D ; �7�� = 9�10 Se. �'T. ; �F5 QuteK H � f � . �� �"\�^�S � - _ F : � - � . 7 t gYa7E� �L � �,.5' � � � . ` -- � . .. � . _ t . - - .. /� � � �1 . 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CROSS SECTION VIEW �- 34�� ` •. . (No Scale) (typlcal) '� . � • a . a,. . .. ' Provide minimum 3 ft System Elevation =96.5 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap ObservatlonPlpe TYPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) (typlcal) Install per manufacturer's PLAN VI EW Instructlons. �NO SCB�e� � ..�� ����Y� � � _ �� � � � � � _ _ � _ _ _ _�`���� ��AP-n >T!�&.���+ � A , � � �� �� A= 3.Oft `�'� � � — � - - - - - - - - - �j� - - - - - - - ��-- - - - ��. ;�! ' r�����tla��,�.n� �riP��q D B = 48 ft —� G� rn (typical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (typica�� � (mfd by Infiltrator Systems,Inc.) � Install pursuant to manufacturer's instructions. � �2 Quick4 Std-W @ 20 fi� EISA/chamber= 240 ftZ + � Pairs of end caps @ 6 ft2 EISA/pair= 6 ft2 = Proposed EISA per trench = 246 ftZ Required Infiltration Area= 900 ftZ Distribution Method: x 4 trenches = Proposed Total EISA= 984 ft1 branched manifold � RESET 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 Disqersal Area Operatinq Limits: Design Flow= 450 yPd; BODS<_220 mgL''; TSS<_150 mgL"'; FOG<_30 mgL"' Insqection 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 c 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 fateral 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(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(s)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:R BtICI P's Earth and Forest Works phone: 715 266 0661 �o�ai 9o„e��me�t,,,,;t: Sawyer County Sanitary and Zoning pnone:715 634 8288 �oca�government unit address: 10610 MBirl St#49 Haywa�d, 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 maifunctioning 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 approvai. 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 shalt be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. .� � � � � t ��..,+s'- . ,� :.�. r . {� i y�' i .� / M li �}.�.. _ II .f�� h�p� , _ � ���^��.� dt ("n�''_�� � <�, � i+ � �y �'„�_" ' � h� i�Y , .� '�' ��!'` � r., r ��•� "� �� 9!a;4'�rL��` • -� � { � ��.'.Y�.�� i�t ✓ cl .f �'.�:'i` ��� ,^ �� t,.,� '4. 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