HomeMy WebLinkAbout004-146-08-0801-SAN-2023-060 Count
Department of Safety y �'� e �
� = & Professional Services, `���l
s' - Sanitary Permit Number(to be filled in by �
_ . Industry Services Division
(� .3�1 �3 7"1 ��
State Tnnsaction Number w
Sanitary Permit Application �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental imit � �
is requucd prior to obtaining a sanitary pernvt.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a �
the Department of Safety and Professional Services.Personal information you provide may be used for sewndary Nv r+� �J
purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats.
I.Application Information—Please Print All Information ��-� ' � k` ��
Property Owncr's Namc Parcel#
�� �.,�k � ��l �� -��'� �- oo� �� o -o�
Property Owner's Mailing Address Property Location a�-i-
� a 3� ���. ��..� �� Go��.�ot
Ciry,S[ate Zip Code Phone Number
� L '/a, 'h, Sechon � l
���. �(� ; ; e (.c�._l- S �7� 1 —
II.Type of Building(c6eck all that apply) L��# T N R E w
t�lor2FamilyDwelling—NumberofBedrooms '�J �(_)� t }��"j�. �l SubdivisionName
�J ( ! I�1
s�o�k# ��; �e �-�i�E- ' l�e',
❑Public/Commercial—Describe Use
�j�n�K `t5 �J� � ❑c,cy ac _
❑State Owned—Describe Use CSM Number ❑Village of _
�� /.'� ��/j � �'Town of �/�L( eJ�Y
�Z ��
III.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A' �New System ❑ Replacement System g y ( p ) ❑ Additional Pretreatment Unit(explain)
❑ Other Modification to Existin S stem ex lain
B.
❑ Holding Tank �,In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
ist Previous Permit Number and Date Issued
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner �,
Expiration
IV.DispersaUTreatment Area and Tank Information: -� `� S'X H ce 1�
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sfl System Elevation �u�C C-33 I
�S� 'Ca �� 3�0 �y.b�� ��S,b
Capacity in Total #of Manufacturer
�
Tank Infortnation Gallons Gallons Units D � �o ,'�, �
New Tanks Existing Tanks � o � � V p � �
n. U cn �n rn w C7 R.
Septic or Holding Tank I O� I � f C y�� `� C'��
I J t.-
Dosing Chamber
V.Responsibitity Statement-I,the undersigned,assume responsibility for instaltation of the POWTS s6own on the attached plans.
Plumber's Name(Print Plumber' ignature � MP/MPRS Number Business Phone Number
�j �' -----
c.< < / /�c�M. � v � //�� ��£SlU �I S'��?�� .�uZsS`�?
Plumber's A ress(Strcet,City,State,Zip Code)
�S C��;� - I� %�t�;n-. '�;'n (��(% (,c,%`��1����; �.v.� SLC�S`1 C�%
VI.Coun /Department Use Only
�.Approb a 3 ❑Disapproved Permit Fee Date Issued Issuing Agent Signature ^
$ Y °' �/�
v! ❑Owner Given Reason for Denial bO• �j I�`1 �3 " - 1
Condirions of ApprovaUReasons`for Disapproval � �
I D
��� ' �r�ti �:�;a�e_ � I�-N ��-� e _
G --
�. .
��hk# � �S� e. MAY 2 4 2023
G✓ I �3— l� ��� -��^¢u � S�'1 SAWYER COUNTY
,,..,. .,, .. ._._._._ ._.._,_
�fv��-} ZONItdG ADMINISTRATION
Attach to complete plans for the system and submit to the County only on paper not less than 8 irz x 11 inches in s'v.e
SBD-6398(R 03/22)
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)
�•Q\je✓�
Pg 1 of 4 Index&Cover Sheet �b�"P'
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): ���!'k� ��.�;E'. 5"'f e�'� Phone: �11� -�_-�
OwnerAddress: � a�i�.3 (YU4;� 12µ>1 �� Zip: �Ll7C�
ProjectAddress: j�l 4�<<� L�a�� ��r.
Govt.Lot: 1/4 of_ 1/4,Section :�,T �`I N-R�_E❑or W�
Township: �c,u���'u� County: S ae✓�F�
Project Parcel ID#: (�(�� ��L �%� �i�v�
Designer Information
Designer Name: C Y'��i��; / `\�n'l�c) _ Phone:7�5 -���- ��L��
Designer Address: �U� 'N �Lt�1�S�� I` Z�P� �����1�-�
E-maiL• U�uiV'��M+Q��G,�� fi J� CciP'1 � �
License Number: ���(`��L%
Remarks:
/ .
Signature: �� _Date: v` '��`,�3
Original sign ure quired on each su itted copy.
CHECK BOX AS APPLICABLE. CHECK 80X AS APPLICABLE.
❑ SOIL EVALUATION o Scale: 140 40� � $o � SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: , DESIGN FLOW: L(S� GPD
-, � (10 grid) 10
m C.L�� K s-�e � Attach design flow calculations for commercial plans.
PROJECT ADDRESS: �. Q�t�'� ���� � � V� N Pipe Material / ASTM Sta�n�ard (Tables 384/.3�0-3 & 384.30-5)
BM Symbol: � BM Elevation: �O �� �� FT Sanitary Sewer: / f � �
Force Main: /
�[ I �1 f\
BM Descriplion: �u�+ �Y7/c 1� 1 r� V��
Slo e Gradient °k Indicate north by IMPORTANT:
p � 1 3`� Well Symbol (If applicable): p drawing an arrow Show ground elevation wntours at suitable intervals.
of Tested Area: on the approprite Iine.
N. a�.��,�� �`
, � -
r�u ' �:e
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�a v � ��a-� o-- r , O ��� � �
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ti Pv�---- ,r
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,5� �� ��.
SEED ANQ LOAM TQ PFiOIECT FROM EROSION ,
� � JY�'i
r— GEOTEXIILE FABR�C
MIN 12"OF
CLEAN FILL
T �
19"
�Z" SPECIFIED SAND ��:,.� I
_1
6" 24• 6"
36"
A42 WIiH 5 OF SAND TO SIDES
SEED AND LOAM TO PROTECT FROM EROSION
�v � J�i
r— � GEOIEXTILE FABRIC
MIN 12"OF
CLEAN FILL
T ;, I
19"
�Z ' � SPEGFIEDSAND �- -,. �
12" 24" 12"
48"
A42 WITH 12"OF SAND TO SIDES �
SEEDAND LOAM TO PROTECT FROM EROSION ��,1�r
� � ��
�_ f
MIN 12"OF GEOTEXTILE FABRIC
CLEAN FILL
7" �
::. . <...-_.,-. _ ..:. . -.���...- "� 19"
12" SPECIFIEDSAND;.. �.. I
_f
� 18" 24" 18..
60"
A42 WITH 18"OF SAND TO SIDES
Figure 1.A42 Single Latera�In-Ground Cross Sections
`�-
Eljen Corporation Page 3 2"?'��
Table 2
SIZE AND ORIENTATION �
< 10 feet= Number of product rows x product
width. Product width is shown in Table 2b;two
rows of A42s can achieve a 6 foot width. Units
may also use up 18 inches of sand on each side of
the product to achieve a 6 foot width. For
Distribution cell width (A)a instance, B43 units used with 18 inches of
specified sand can achieve a 6 foot width; refer
to Table 2c for configurations. A 843 unit with 12
inches of specified sand on each side can be
placed in two rows to achieve a 10 ft wide cell.
>_Design wastewater flow rate=design loading
rate of the fill material=square footage of
product(shown in Table 2b), round up to nearest
Required#of Products whole number; Min 5 B43 units per bedroom or
6 A42 units per bedroom in residential
applications
Distribution cell length (B)a Multiple#of GSF units x 4 ft+1 ft
Longest dimension parallel to surface grade
Orientation contours on sioping sites.
Deflection of distribution cell on concave < 10%
slopes
Design wastewater flow=soil application rate for
the in situ soil at the i�filtrative surface or a
Basal area lower horizon if the lower horizon adversely
affects the dispersal of wastewater in accordance
with s.SPS 383.44(4) (a)and (c),Wis.Adm. Code
The designer may use Effluent#2 in accordance
Soil Application Rate with s.SPS Table 383.44-1 and 353.44-2,Wis.
Adm. Code
Table 2b
APPROVED PRODUCT MODEL NUMBERS AND DIMENSIONS
Product Square Footage Product Width Produtt Length Product Height
A42 12 square feet per unit 36" 48�� ���
B43 16 square feet per unit 48" 4$" ���
Table 2c
APPROVED PRODUCT INSTALLATIONS AND SQUARE FOOTAGE
Product Square Footage Instaflation Width Installation Length Install Height
12 square feet per unit 36" 48" 19"
A42 16 square feet per unit 48" 48" 19"
20 square feet per unit 60" 4$" 19
16 square fee[ per unit 48" 48" 19"
843 ZO square feet per unit 60" 48�� 19
24 square feet per unit 72" 48" 19"
EfjenCorporetion Page �'� �� L)
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 Disaersal Area Operatinq Limits:
Design Flow= �S� 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, vaNes, 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 ot 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, etc.)
o distribution lateral or lateral orifice piugging (measure lateral distai 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 servicing operator licensed under s. 281.48 Wis.
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 co�tents 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 servidng 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: ��� � Om�S�!� d ���ti 5 EY�C �[C Phone: � f S' ��v-��`�� _
Local government unit: �Sa r��yPl��u�-/ �Ol��l�, Phone: 7( 5- �O 3Y—�����
Localgovernmentunitaddress: �����D /�u�n S� S«°T�#��� ��w•�°'l ZIP: 5�����3
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.
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.