HomeMy WebLinkAbout002-103-18-2601-SAN-2023-062 _ � Department of Safety c°°°`y �
-� � - & Professional Services, s aw c r" � '
_ . Sanitary Permit Numb r(ro be filled in b�
�= Industry Services Division
,.. . U' 3�� 3 �`� �.��.t
Sanitary Permit Application State Transaction Nu�_ber j
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[n accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 6-
is required prior to obtaining a sanitary permit.Note:Application forms for state-owmed POWTS aze submitted to Project Addcess(if different than mailing �
the Department of Safet�and Professional Services.Personal information you provide may be used for secondary 1
purposes in accordance with the Privacy Law,s. 15.04(t)(m),Stats. �995 N �vST Av�
I.Application Information-Please Print All Information
Property Owner's Name Parccl#
l�cd�c, 1 oo�-1U3-18-0900 (t ��oo ��o�
Property Owners ailing Address Property Location
oa9 N c.a��� � K ���� �o�
City,State Zip Code Phone Number
' `Q W Q r` �,L 5,.�8 y3 '/., Ya, Section 3�
1"� a
II.Type of Building(check all that apply) Lot# T 0 N R O t-er
�or 2 Family Dwelling-Number ofBedrooms � Subdivision Name
9-�s ac.-3�
Block# (�b� pc�. } 4C4�
❑Public/Commercial-Describe Use
� $ ❑City of - -
❑State Owned-Describe Use CSM Number ❑Village of
...�— '�f`I�own of L7C�,55 Lo�<C _-_—
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 i
a licable.
A �New System ❑ Replacement System
❑Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding Tank �In-Ground ❑At-Grade ❑ Mound ❑ tndividual Site Design Other Type(explain)
(conventional)
�'• ❑ Renewal Before ❑ Revision ❑Change of Plumber ist Previous Permit Number and Date[ssued
❑ Transfer ro New Owner
Expiration �V Y 2 2-00 g
IV.DispersaU'['reatment Area and Tank Information: 3 O A��e�e q �i�s Cha+-� s�s w i � sLts vf t.+e�
Design Flow(gpd) Design Soil Application Rate(gpci/sf) Dispersal Area Required(s� Dispersal Area Proposed(st) System Elevation
30o n. s �.a d G�a 93 . 00 �f
Capacity in Total #of Manufacturer
Tank Infortnation Gallons Gallons Units � � o v �
ca v U �'
New Tanks Existing I'anks ` o g; ` � � � c`"a
n. U in �, rn u. C7 a.
Sep[ic or Holding Tank 7s� � �� � i C C' Ptt�'C
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POW7'S shown on the attached plans.
Plumber�s Na�ne(Prin[) Plumber s Signature MP/MPRS Number Qusiness Phone Number
� n, ►�� �'� �� a �, •ss$-�y ti
Plumber's Address(Stree[,CiCy,State,7.ip Code)
9 a�sH s+a� Ra�.�. a� a War� w� sy�y
V1.County/Department Use Only
Permil Fee Date Issued Issuing Agent Signature
�Ap ❑Disapproved $ _
❑Owner Given Reason for Denial I�� -S� a S'a 3 ��.�',��}�r�✓'��+-
Conditions of Approval/Reasons for Disapproval ; i� �`-, ;�/
,�S ��� ._�._.____ � .;i --
� � "1 :��t�____�.s._-�-�- , ,`
�` ' ���►� ��s�t�� ._._- �� MAY 2 4 2023
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Attac6 to complete plans for the system and submit to Me County only oo paper not less than 8 I2 x 11 inches in size
NO R�F�IVDS AFTER .�����`�
SBD-6398(R.03/22)
ISSUE OF P�F'cM1T
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
Olson-Post Ave-NW Beach
Owner Name(s): Rodney Olson Phone: - -
Owner Address: 8029N County Hwy K; Hayward,WI Z�P: 54843
Project Address: 7995N Post Ave
Govt.Lot: 1/4 of 1/4,Section 30 T 40 N-R 08 E 0 or W❑✓
Township: Bass Lake County: Sawyer
Project Parcel ID#: 002-103-18 0900(8�1100,2601)
Designer Information
Designe�Name: Ronald A Spreckels Jr Phone: ��5 _558 _6472
Designer Address: 9205N State Road 27;Hayward,WI Z�p; 54843
E-mail: ronspreckels@yahoo.com ,, �,- i,�,��, �
License Number: 226688
Remarks:
Signature: �,�G�i�'i^�'d Date: os/��/a3
Original signature required on each submitted copy.
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Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA WieserConcrete Inc
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s)
3-ft Trench (down-sizing credit) �50 9a, gal 9a� gal
Effluent Filter Manufacturer:
Lifetime Filter LLC
i
etn�e�c Fu�er rnodei a: LT-1/8
min.12"
SOIL COVER (rypl�l�
i z•
min.Uench
cno�n • TYPICAL TRENCH
—— ".a • CROSS SECTION VIEW
��ry�,� (No Scale)
, ' ...� ;
Provide minimum 3 ft
System Elevation = 93.00 ft separation between trenches.
(rypical)
Quick4 Standard-W
w/EndCap ObservatbnPlpe TYPICALTRENCH
(typical) (Show location of inlet/ outlet pipe connection on plan view.) Install perrymanufacNrefs PLAN VIEW
�°s"°"�°°s (No Scale)
� �s.�w..�e��- - - - -�� - - - - - - - �'� — - -���►+r � � F�3�,�� �
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, ,� I A= 3.Oft
�[sFiiW++acr�► �� — — — — �� — — — — — — — �� — — �—��l _ilai��ai�' n� (�YPical) �
g = 63 ft �; m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (�yPi�l) �
(mfd by Infiltrator Systems,IncJ �
Ins1aU pursuant to manufacNrefs instructions. �
15 Quick4 Std-W @ 20 fl� EISA/chamber= 300 ft�
+ � Pairs of end caps @ 6 ft'EISA/pair= 6 ft'
= Proposed EISA per trench = 306 ft� Required Infiltration Area= 600 ry� Distribution Method:
x 2 trenches = Proposed Total EISA= 612 �� 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 pian.
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= 300 yPd; BODS <_220 mgL"'; TSS <_ 150 mgL"'; FOG <_30 mgL"'
Insaection 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-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 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 servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (113)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 shail 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: ROil81d A SP�eCk21S Jf Phone: 715-558-6472 _
�ocai 9o�e��me�t ���c: Sawyer County Zoning & Conservation phone: 715-634-8288
Localgovernmentunitaddress: �OO�O M81f1 St, Suite#9; Hayward, 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 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.
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 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.
;���trA"'`"E�'r; PRIVATE ONSITE WASTE TREATMENT County
������sp$ ',�`ti SYSTEMS SaWyer
( POWTS)
.\N � _�/"� .
z ' � INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3�6(0�
Personal infonnation you provide may be used for secondary purposes[Privacy Iaw,s. 1�.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�,o�v.� 6`s�•,, ^55 �1�- _
Insp BM Elev: BM Description: Parcel Tax No:
l o o,a N a`,� +���� \� l'�'' 0 4�C �r�-- oa� -l�.3-(g- �6 o I
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w�e�— '7'S'j� Benchmark /oo,c�'
Dosing
Aeration Bldg. Sewer --
Holding St/Ht Inlet 9 Y•o
TANK SETBACK INFORMATION St I Ht Outlet c�,q '
TANK TO P/L WELL BLDG vENr To ROAD Dt iniet
AIR INTAKE
Septic �S' � �- NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 93� �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �a � �
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W � � $ ` #of Celis Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �� ,
INFORMATION P/L Bltlg Well Waters � GP y� Chamber Model Number:
❑ EZFIow
CELL TO ` ❑ Mound o Other
- -- �}"�_ -?-t a _Ili N --- —_ `-r`�- -
DISTRIBUTION SYSTEM X Pressure Systems Only
Hea�der/Manifold Dist9bution Pipe(s) — p !i X Hole Size S Holeg Observation Pipe�
Len th Dia Len th Dia S ac pacin ❑Yes ❑No
C --
SOIL COVER
--- -- - ---- - -
( Depth Over Depth Over T Depth of Seeded I Sodded Mulched
Cell Center � Cell Edges � Topsoil _ � ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
�a��� 6 l�(z3
� � �! � �
Plan revision required7❑Yes❑ No ,63 oK �Y I; � �� � ��
__ ._—__
Use other side for additional information Date POWTS Inspector s Signature Certification Number
SBD-6710(R.3/01)
AODITI�NAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBER:___�-�_-'�C�o2____
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