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HomeMy WebLinkAbout028-742-34-3306-SAN-2023-134 v� Department of Safety �O°"" � �J D � &Professional Services, z . t sU��w�Pcm,��nu e���w x ruca��ey c �= Industry Services Division R� (�s I C�-i`i � Sanitary Permit Application """'`°°'J"'°"'�"'»b" ,�,, n,a�«,�aa�,��w��n srs sss.z i rz�.H��.nam.c�a�.���n�,�,.������m��r�,m,���i,�an������at������,�„�„r i����� '��"0(o?�3d�.Z'C- � is rcyuircA p�im�«�obtaining a unitan�permit.Nutc:Application formv f r stem-owncd POWTS are submitmd m Projcc�,4ddrcss Ii1'diflcrcm than mailing ad the Dc�ertmcnt of Sutery nnJ Prokssional Scn�ices.Penonul infortn��iun yuu proviJe m��he used f r uwnJary n��mo��.�„����,�d����.�ai,m�r���n�y�w.s.is.oa�n��,�.s�n��. Sclr�_ 1.Application Information-Please Print All Informatiou Propcn�Ouncr'.Name Parccl� ��� G �:�-� G�-t�� D.�P-?�i-s�3-3�6 Prnpem�O�vner's Mailing.4ddrcas Prnperty Locatinn /og4G t,� T�� Gt.�-ti IQv,r.� �:�,�,��,� C'in�, tarc ZipC�slc Phoncrumhcr � L h�`�5�� �/S��4GZ-3 7? `� q;..� .s������� ❑.Typ of Building(check all that apply) �A� T C�r R 0� E u ❑I or'_F'a�nily Uwellin�-VumberofNedruoms 7 ��p Suhdivision Vamc � ����/ B ,���L3 4 ni��ic�mm«<�Ai-o�x��nE u.�/ �� ❑c��Y��r --- ❑Smic OvmcA-Dcscribc C�c �xr ❑A'illugco( �`f-1— �„r 5 �or2 L.�at�'--- IIL'fype o(PON"CS Permit(Check either"New"or'•Repfacement"and other applicable on Gne A.Check one box on line B.Complete line C if a licablc. ' N�w sy,���» C k.�i:����»�„�s�.���„ ❑o�i,�����,a�r�,r�,����ex�s���b sys���,��z�i���i ❑nad�����,.,i r�����•:,���,�„�c�d�a•.�i:���,i �' ❑Iloldinglank �ImGround ❑A�-Gnde ❑Mnund ❑IndicidualSitelksign ❑Oiherl�ype(explainl (comentional) C. ❑Rcncwal I3cforc C Revision ❑Chungc uf Plwnber ❑Transfcr to Vc�c Owncrl.ist Prceinus Pcnnit Numbcr and Datc I,wcd ex���,���„�� q`-r-00`j 1�'.DispersaV'1'rcatment Arca and Tank Intormation: I)e: Flow�(g�d1 1)exign S�ii Application Ra�e(gpdhfl I7i.per�,�1 Area Re ed(�f1 i I)isper.�I Area I'r�ir�ce�i(ctl Syc[ein HI tion 3 •� /9�� Zr90 �6.D Capaciry in Total #o( Manutacmrcr I fank Intormatinn Gallons Gallons Units a _ � ._ �c�c���avA. �!.i>n,g-faoks t�'� � 2 _ � L.� I l: G Scptic<rt nk ov � O � � I)i�.i�,_Ch.inilx�r � ' I I I �'.Responsibility Statement-I,the undersigned,assu esponsi or iospllation of the POR"fS shown an the sttached plans. Plumbcr'.Numc(Pnm) Plum r g�« MP MPRS Numbcr Rusincss Phonc Sumbar / �L >34�{ z �.s 77G-/99 ri��nn�r�nda«�,�is,«���,c��y.s�an,z��r„��i .SDD GL � d� GP C-�Yi� cS Pl�P \'L Couna�/Department Use Ooly �Ap�C�� ❑Disappmced $zurniit Fee Dzte Issued Issuing.�gent Sienaturc �Y✓ ❑Uwner(iiven Neasan for Uenia� 1�•�D ����I'�'3 " I�z�'�t�''" "- Conditions of A��provnVRtasons for Disapproval f-��;�''r�v�,c\rl C 5 �'�►j � � :ace._?1i1��"3 '�')� '��� \�/ �°;iV �����'�W�� �nka_153�`? ____ �5 JUL 10 022 3 � � � � . ��5� �� --C�,�' �t#,;�-�"7_L . _ SAVV`(EFiCOUNTY ZONING AGMINISTP,AT!OtV At1acM1���complete pla�r fnr Ihe s���tem�nA�ubmil lo Ihe Cuunly nnlv on p>Per nu�less IXan N 1�3 a 11 incM1es in xii.e NO REFUhD�AFTER sBo-bsvx�a.us�zz� ISSUE OF PERMIT ';,1�� \NI \���/_ Wisconsin Department of Safety and Professional Services _ " '� Phone: 608-266-2112 Division oflndustry Services �� Web� htip�J/ds�ci�o� 4822 Madison Yards Way - � a �; Email: �,� « ��iticunsin co� PO Box 7302 ' Madison, w153707 a � Tony Evers, Governor „ , „� ,�:�` Dan Hereth, Secretary June 30, 2023 CUST ID NO.: 139462 Identification Numbers TODD L SINZ Plan Review No.: PWTS-062301292-C E5609 708TH AVE Application No.: DIS-062327866 MENOMON[E, WI 54751 Site [D No.: SIT- I 17488 Please refer to all identification numbers in each correspondence with the Department. CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/30/2025 MUNIC I PA LITY: Co�DIrlo.r;�LLY TOWN OF SPIDER LAKE APPROVED SAWYER COUNTY �ePT �F s�= ..�r nr;_ �,,�;__�s�or:+:. s��vz�Es DiVi.SiGN (�r .._ . � �t ( 5��;�,::..E.`i SITE: TOWN OF SPIDER LAKE �'E� ��� 10896 W TOWN HALL ROAD — see cc. ;.�:;,-or�u�t.�e HAYWARD, Wl 54843 SW I/4 SW I/4 S34 T42N R7W FOR: Design Wastewater Flow Value: 193 [n-Ground Soil Absorption Component Manual - Version Publie Use: Town shop — 3 employees and 2 utility floor drains 2. 1 (May 2022-2027) Limiting Factor(s): 96" Maintenance Required: Effluent Filter SITE REQUIREMENTS • A full size copy of the approved plans, specifications, and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is designed to serve only the uses indicated on the plan and only domestic wastewater. If the use of the building changes, new approvals will need to be done and additional components may need to be installed. The Department of Natural Resources must be contacted regarding the treatment and disposal of all non-domestic wastes, including those combined with domestic wastes. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic tank that may be required for this project. OWNER RESPONSIBILITIES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code & SPS 383.54(1 ). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enelf�sed a�proved gla��s and urith any c�n�}xment manual(s)referertced ttl�o�e. Tl�e c�wa�c;r,as�eii��ec] in chapler 101.41�(1t)j, �'iscorisin Stahites,is r�sponsible fc�r compliance with all cede��equircn�cnts. No gerson�nay engdge in or u�ork at pluinbing in tl�e state unless ficensed;o cio so bti tl��De�ar��rlent per s1�1`�.Ob,stats, All�er�nits required by the state or the local�7�unicipality st�all he c>htained prior In comn�en�e�nen[of construction/ii2stallation/operation. In granTing tl�is approval,the Division of In�ustry Services reszrves tl�z righ[i<� rec�uire chan�es or additiens,shf�ulcl ci»�i3iti�n5 iris�, rnaking the�m necessary for c��de cr�mpliance. as per state stats 1li1.12(2),n�thin�in t}�is re��ie�v shall��elieve the desi�;ner of the res}�onsibility far desi�ning a safe buildirlg,structure.,c�r co7n��z�nent. The Dis�ici��n dees not ta3ce responsil�ility#or thc dcsig��«�� construction oY the reviewed items. L�quiries eo�Icerning this correspandence�r�ay be nlade to me a't tl3e cc�ntaet inforn�ati��ra listed bel�,s�,or�at the a�clres�c�n tl�is letterhead, lincercly, ! �� , . I ee I..ci�uirecl: `�?��.()� ' Pee REcei�-ed `�?�U.(1() �r��p�`:� ,.��,...�; ,� � I3a1�anLe L)�ic �C).t)�J _ 4 f..! / l �.L*(��7-�r'A°%.+f'r°A � L;lizabeth Rudn�iki i Refund Ex��ecte�: $0,(_lf) llivisian of l�d€�stry Services Yhoz�e: 6()�-�1(1()-31�ti I:mail: elizaheth.rudnicki'Li wisconsin.gc?v on-Grour�d Gravl� P9an tnd�x � Cover Sheet Componerrt Manua!Design References In-Ground Soil Absorptlon for POVV7S Versbn 2,1(May 2022-2027j Pro7ectName: ;�'L✓�9 G''r �j-�ii�..`+L G���; Y/��'f-� �_ ,�' �� / � ' Owner'sName: /G'�'+�i"' �'•" �/�/�Li� L-�fX'!i Owner's .-� / � nddress: �L����� (L� /��..,'✓,� �.tYrLL �G��S] � ;Zt//1,�1� C���� ��f�Y�`'�5 ---- Legal DeScriPtion: �C�'f'f �����/ S.�/ %�f?-/� ���1� �`-� Municipality: ow��Vi4k�-Eit�Of ���i J�rG Lrr-KF County: C;/'��`�,' SabdioisiomNsn�e:) �>-%� 7-�'G ��'l'�''I-= Lot Num6er: Block Number: Parcel 1.D.Number: v<<�%`f 7 ��S .SC�L% Page 1 �i�l�i�� /f7;'G' ��(�i/.C�4 ���i � �� Page 2 /L i';� f! � Page 3 ���l�i `'/�1��i ��ji C j/f;;j� Page 4 ,G/L�—yGi!vi�t�� ��/S f�'�=/'�'�t.-1 �7'C/r= ��1�� � Page 5 �� f'��l��J �������'C�Tjt� �f�fr'j / � / Page6__ G/��%j.14� �/—Gl�ir.�.�'%� �'��f-c� Page 7 (,iCch�C�-i j�f�i'f�/�i�, Page 8 �i✓�l'�:�.�i�f�it:''i� �L-/'rYL� Page9 �i� /fi�/ %� � C�.��.�.,.._,.i:i'�,'I Y;.�' Page 10 �.'/ %�S'=� /' 1' APPROVED Page 11 �A�� /f`S i f�% DEP'i OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Page 12 Vage13 �I�� ��� Page 14 SEE CO.kcSPUNDENCE Page 15 rvame'of Designer: ��O v G j.✓l- License Number:�'`� /S i�/G� � 5�gnature: Date����_�f/i'?� i • -- //// _ � _ _____..___ _._____ _. ______ �._ � _ _ _- � � t y �y � �€ r � £ �� � � ; ) O � � � t i � � }` � � ��' � � � `��� a- � � } e -�, � � � � ~ � � d" °"� �'' � r � p �p � � � �-- s- � �r "_� �� � ? � �' ,� � � �? � � `_' ...,.� �. 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(���zE�I."t. ��f�C'L!�4�I`A�`'�Fd:�sC3td Fh"'C;t'�o2 7�IE�i*!I��'dt�f�'C}i �l'i.�.t4!T��?�t1€?;=C}E�FICtIC_�"�F2 la"v1f'C?S�Ii',1_�.. ��C7]T[C7?�A� L:47Cs�M�N7S: T'G'�IVT� INS`("AL��R F'�34�175��,�(t�"iJAli�d�F; � _ ���T�Tii ` : �----- __.._ ._____._._— , �- � � � . _� �_ '���ST, �: — — . _' -` _ _:. �= �r �_ , � __— i — _ �'�lc, �P � � �7 tt�; ( � T , , �. �� — __-._ _ € __f m �-- .__' _ �_ —.. :. _.�__�_ �_ —_.. _ _.._ _. _...._t SI�PT�1�� i�$�:;�iCii3G(�F'�RAT�}P� P�IE�1iF'EIi) ��t;�� q��LJL1�T`C7�`(�i11TH(7F�iT'f I`� t � � � _ � ._. _ ,._ _ _.� � _ _ . �_.W......�-_,...._ i���i` i j ( r � __ � _� � �__ _ — }7.1,.� _- � _.,._ �.I��lC Y1t� � �< _���P State of Wisconsin Tony Evers,Governor DEPARTMENT OF NATURAL RESOURCES Adam N.Payne,Secretary 101 S.Webster Street Telephone 608-266-2621 P.O.Box 7921 FAX 608-2673579 Madison WI 53707-7921 TTY Access via relay-711 W�sca+siN �� OEPT.Oi N�NN�L FESOUHCES I J��l��.�'�.`Jr� L�l � September 29,2023 /'� �� IlJ� Project No.5-2023-0705 " SEP �D Mark Weis ?9 ?023 ,2500'ColPege bing Z�NN�pMN�TRqTI 0!y Rice Lake,Wl 54868 Subj: Industrial Wastewater Holding Tank for Spider Lake Town Shop in the City of Hayward Dear Mark Weis: The Department of Natural Resources has received and reviewed your recent transmittal of completed WDNR Form 3400-185 for your proposal to install concrete wastewater holding tank manufactured by Skaw Precast at 10896 West Town Hall Road in the City of Hayward,Wisconsin.The tank will have a 3000-gallon capacity and will hold non- domestic wastewater.The industrial wastewater will be generated from motor vehicle fluids(oil,grease,etc.) drippins or spillage from vehicle or equipment service areas.The owner of the holding tank will be Spider Lake Town Shop. According to your submitted form,the wastewater to be contained in the proposed holding tanks will be hauled by Scotts Septic Pumping to the City of Rice Lake Wastewater Treatment Plant for ultimate treatment and disposal. Based on this review,the proposed installation is acceptable to the Department of Na[ural Resources. As part of this acceptance,please review and discuss the conditions of approval with the tank owner,as outlined on page 3 of WDNR form 3400-185,prior to installation and startup af the proposed holding tank. Please note that the Department of Safety and Professional Services is responsible for review and approval of any catch basins,sewer lines/connections,and other plumbing appurtenances associated with the installation of the proposed holding tank,as well as the use of the proposed holding tank for storing sanitary wastewater. If you have any questions concerning this acknowledgement,please contact Josh Lambert,WDNR Madison office,at Joshua.l ambett(m,wi sconsi n.�ov. STATE OF WISCONSIN DEPARTMENT OF NATURAL RESOURCES Forthe Secretary �a�llL(',��Qit.t Joshua Lambert Wastewater Specialist Bureau of Water Quality Cc: Spider Lake Town Shop—Owner,10896 West Town Hall Road,Hayward,WI tim.sheldon(c�townofspiderla kewi.Rov Jay Kozlowski—Sawyer County Zoning and Conservation jay.kozlowski@sawvercountv�ov.or� Alison Canniff—DNR,Ashland Service Center alison.canniff@wisconsin.�ov dnr.wi.gov � wisconsin.gov Narurally WISCONSIN ;,;:�"'"T"E���,>;. PRIVATE ONSITE WASTE TREATMENT county `-����o '��� SYSTEMS = $P ,- Sawyer ����� s ( POWTS) �, ,,, ,,. � ,�,,, ,: �"`'"'""';� INSPECTION REPORT sanitary Perrnit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 23 -- � � Personal infonnation you provide may be used for secondary puiposes [ Privacy Law, s. 15.04 (1)(m) ] Permit Holder's Name: ❑ City ❑ Village I� Town of: State Plan Transaction ID#: o..,� �. o� S � C�l,c�— 5 � l�(,c-e. P�3 -0��36� .24�- - C Insp BM Elev: B Descriptio�: Parcel Tax No: �c;o.� r3b�► o� r�� s�o�:' o� s� o�g -7Y.2 , 37- 3�a � TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic s�v�/ pp Benchmark �p, o' Dosing Aeration Bldg. Sewer c�$. Y � Holding St ! Ht Inlet Q�, g ` TANK SETBACK INFORMATION St / Ht Outlet q7 � � TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet AIRINTAKE Septic �' � �o ` ,��p � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header / Man. 8' Holding " Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative i Surface QS`� 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 �(p # of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P / L Bldg Well Waters � IGP ❑ Chamber Model Number: ❑ AG 1� EZFIow CELL TO ?��� ❑ Mound � Other _ _l`�_ _�__ N ____- _- - -_ _ - ------- - DISTRIBUTION SYSTEM X Pressure Systems Only Header/ Manifold Distribution Pipe(s) �Hole Size X�ole Observation Pipes Length Dia � Length Dia_ _ Spac _' Spacing ❑ Yes ❑ No � SOIL COVER __- -- -- --- --- - -- — - -- — _ Depth Over Depth Over Depth of Seeded / Sodded Mulched � Cell Center Cell Edges I Topsoil ❑ Yes ❑ No � ❑ Yes ❑ fJo COMMENTS: (Include code discrepancies, persons present, etc.) ��-�11,� �1����3 Plan revision required?� Yes ❑ N�� � , �, � � � � • � ��0 3 ; l 1 I"l , �— � � �`T�(� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710 (R.3/01) AODITIDNAL COMMENTS AN� SKETCH SANITAAY PERMIT NUMBER:__�3^I 3 y_ �1� .�� T � ` qv 0 ��, ,���P�I,�. . '�(o�t� � S\ � '��D--�� b �. ^'� ��° � (�-' � i . Ko �� � �1 e."' E...__ (q�--J � s�,� . �, fiav+n [� � �u�P 0 ,�" �v wDN� N•� . 5��a �jM• e�•��� S�^�� 1 I � - "�-- i