HomeMy WebLinkAbout032-539-03-5211-SAN-2023-140 ' ` Department of Safety c°°°`Y �
0 & Professional Services, CiYS/Vpr �'
sf s � Industry Services Division Sanitary Perm�trNumber(to be filled in by �
� S � OSa �v
_ �
Sanitary Permit Application State Tcansaction Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govertunental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for statc-owncd POWTS arc submittcd to Projcct Address(if diffcrcnt than mailing; �
the Department of Safety and Professional Services.Personal information you provide may be used for secondary 7096 N N�q I1M Rd
pu�poses in aecordance with the Privacy Law,s. 15.04(1)(m},Stats.
I.Applicatian Information-Please Print All Information wl e y a 9�
Property Owner's Name Parccl#
e' � os25 3 1
Property Owner's Mailing Address Property Location
y '►�► 5+, Govt.Lot 2
Ciry,State Zip Code Phone Number
��s� ����� --- —'h, — _'/A, Section �
IL Type of Buitding(check ail that apply) Lot# T N R_�E o�
61 1 or 2 Family Dwelling-Number ofBedrooms Z. Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
C�Townof w1� 7er
III.Type of POW'I'S Permit:(Check either"New"or"RepiacemenY'and other applicable on line A. Check one bog on line B.Cumplete line C if
a licable.)
.4.
❑ New Systcm � Replacement System Q Otficr Moditica��on to F.xisting System(explain) ❑ Additional Pretreatment Unit(explain)
e ic n�k l e
B' ❑ Holding Tank ❑ In-Ground ❑ At-Grade gn yp p )
❑ Mound ❑ Individual Site Desi ❑Other T e(�x lain
(convcntional)
C. ❑ Revision ❑ Change of Plumber ist Previous Permit Number and Dxte Issued
❑ Renewal I3efor�e ❑Transfer to New Owner
Lxpiration bw � '� �$ ��
(I
IV.Dispersal/Treatment Area and Tank Informallon: �
Design Flow(gpd) Dcsign Soil Application Rate(gpd/st� Dispersal Area Required(s� Dispersal Area System Elevation �
-7 �1�8 Sa •
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units p � v � �
C! U U n y
New'fanks ExistingTanks y o a� y� � p � �
a, U in „ rn i,. �7 0,
Septic or Holding Tank SM ,�,.,r �OO � uur�f x
OW �l ?�
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of t6e POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Si�mature MP/MPRS humber Business Phone Numbcr
t .2.2 28'I 7 I5 9�4 90
Plumber's Address(Strect,Ciry,State,Zip Code)
O N M' N W
VI.Coun lDepartment Use Only
Permit Fee Date Issued Issuing Agent Signature
,�App � ❑Disapproved $
/� 0 0 � ' � � M^
O Owner Given Reason for Denial �DV' � � �3 _' `"I����-L
Conditions of Approval/Reasons for Disapproval ��� �n 5"'��
` � �� .
�
'��3�.c..�. ..�.,�. � '�._Jl:
'� �.�-3 . . �.4�_ - � ;
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�IN�� � �
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�hk# } JUL 1 7 2023 �
Gs'��3— �a� , .r.�3, -���y _. .
SAWYEFI G:.
ZON{NG ADMItJIS'f�i�u�vi+t
Attach to complete plans for the system and submit to the Couoty only on paper not less than R ll2 x t t inches in size
3�-��7 0�7
SBD-6398(R.03/22) �(7��FJN�S AFTER
IS.,UE O�P'ER�U;II"
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 Ta�k re !•
Pg 4 of 4 Management Plan °�� -N�
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Marchi
Owner Name(s): Keith and Mary Marchi Phone: - -
Owner Address: 4932 W 119th St. Alsip IL Zip: 60803
Project Address: 7096N Malm Rd. Winter, WI 54896
Govt. Lot: 2 1/4 of 1/4, Section 3 , T 39 N-R 5 E Q or W �✓
Township: Winter County: Sawyer
Project Parcel ID #: 032539035211
Designer Information
Designer Name: Kurt Brown Phone: 715 _943 _2988
Designer Address: 10487 Old Murry Rd. Exeland, WI 54835 Zip: 54835
E-mail: brownk@bevcomm.net _ _ _ . �,. ,.,� u. , w
�icense Number: MPRS 224281
Remarks:
Signature: Date: 7�/3�23
Origin I signature required on each submitted copy.
CHECK BOX AS APPLICABI.E CHECK�X AS APRJCABLE
Q✓ SOIL EVALUATION o �=�40' � � Q✓ SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME {�o a� 102 oEsrcn�ow: 300 cPo
Keith and Mary Marchi nn�r,�,no��«,�ror��u.
wzo.�crnoo�Ess_ 7096N Makn Rd.W�W154896 P'ipe Ma�erial/ASTM Smnda�d(fa6les 384.303 8 38�_30-6)
e�u��na: � aw+e�: 100A � N sar,�`�'se,.�r: 3� �
��p,�,,; Top of house deck. ��� � �
���(%) ��nnby IMPORTAKf:
d Test�l4eg �°� W��(�aPP��k Q ���'S��� Show ground elevation aonlotss at siatable inte�v�s.
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Department of Zoning and 5anitation
Sawyer County
Inapection Report
Owner �pRir� �1 MaRChc Addreea/yy09 ��(ncksfdve �a��"eN TLL. GO`//j
Description NE%y SF_fy Sec 3 T35n� �S4/ LeT i% GeY7c<r
� Z
Name oP busineas
Builder Address
Plumber ]��,,,aL�J ���seW Address W.r.If"�2 �✓l•
Inapection
(l�Private ( ) Public Property Sanitary install
Dwelling Privy
Violation Mobile Home Setback-lake
Garage Setback-road
( ) Sanitary ( ) Zoning Setback-lot line
lJAR�R l.ake
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Dipcussed with owner ( ) yes ((( ) no
D��scussed with builder ( ) yes � ) no
Discussed with plumber ( ) yes ) no
Dete /0- /5- �7
S ignature of Off icer /.�C.o�.2=,..�- ��+-�en a-... /°z�
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 353.52(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= 300 gpd; BODS 5 220 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 adivities, 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(sl 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 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 repoAs 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: R011dy D2f1111S Phone: 715 415 0662
�o�ai 9o�e��me„t ,,,,;t: Sawyer County Sanitary and Zoning Pnone: 715 634 8288
�oca� 9overnment unit address: 10610 Main St. #49 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.
CHECK BO%AS AP%JCAOLE. CHECK BO%AS APRICABLE.
0✓ SOIL EVALUATION o sca�e:4°o ao� � 80 �SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
. PROJECT NAME:
�iortAnel io� oesicHF�ow 300 �co
_ Keith and Mary Marchi Atlach tlesign flow ralculations for commercial plans.
Pawecr nooness: 7096N Malm Rd.Winter,WI 54896 Pipe Matenal/AS7M Standard(Tables 384.343 8 384.30.5)
N s�uaryse,.�, 3034 �
eM symea�.!�i sM Fi�a�o�: 100A Fr Fau nna�o�. NA
eM oesrnPno�: Top of house deck. �
Slope Graaknt�%) u���wm�onn eY IMPORTANT:
0�Tesle�Area: �� ti'ell Symbol(Rapplicable)'. � d.arirg an I e�e. Show ground elevation contours at suitable inlervals.
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o� ���� �
JUL 2 8 2023
SAWYER COUNTY I
�ONING ADMINISTRATION
I