HomeMy WebLinkAbout002-157-16-0400-SAN-2023-141 Department of Safety c��,ncy �'�
��uy e� �
0 a �L Pl'OfCSSIOriaI SCI'VICCS� Sanitary Permit Number(to be filled in by �
Pg Industry Services Division
� � 1 �51 5--�
— �
Sanitary Permit Application State Transaction Number �
ln accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit �� �
is required prior to obtainina a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailin�t —
the Department of�Safety�and Protessional Sen�iceti.Personal information you provide ma��be used for secondary
purposcs in accordancc with thc Privacy Lati�,s. 1 i.04(I)pn).Stats. �J�, q •/
l.Application Information-Please Print All [nformation -y�� 1 �y 1V ���r (V��[�Sah (}vL
Propert} OHner's Name Parcel#
S��h JC'l0.C�Q� m0� .� r,J �— I b� 0�0�
Property Owner's Mailing Address Property Location
2 $S2 3��1 5�-rec� ��
City,State 7.ip Code Phone Number
�;�.� C�c..ft � W( ��70� --�`���Section 3�
lI.Type of Building(check all that apply) t.ot# T �0 N R �g E or�
�or2 Family Dwelling-NumberotBedrooms 2 ��q 37�-3$ Subdivision Name
1
Block# o� (,('("
❑Public/Commercial-Describe Use / � /
�b �A ❑c�cy or�
❑State Owned-Describe Use __ CSM Number ❑Village of
� �;r�w„�r_ O�.ss �a k c_
lli.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
��� �New System �� Keplacement System � I Olher Modification to Existing System(explain) Additional Pretreatment Unit(explain)
B• i I �
❑ Holding Tank In-Ground ❑ At-Grade l_ Mound � Individual Site Design ` Other Type(esplain)
(conventional)
r, r- . List Previous Permit Number and Date Issu�d
C• n Renewal Before n Revision � �, Change of Plumber �, Cransfer to New Owner
Gxpiration �
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(st) System Elevation
3 0� . � S'oo s� Z �2 - 9��. S,
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units � U � � � �
Y U 'y U vi �
New Tanks Existing Tanks ` c ` � � � �
c
a Ci ✓� �, v� i�. C7 a.
Septic or Holding Tank 7 S`O 7So �
� �S1,r
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber�s Sign re MP/MPRS Number Business Phone Numb�rr
� �q.� ���.,�� �' l-S-16 I�.°� ��� � .��g._ i-q oy
Plumber s Address(Street,City,State,Zip Code)
����� �,��.�wl�' r�. s�o�� 1��� - w; sYg7�
VI.Count /Department Use Only
�App� � ❑Disapproved Pcrmit I ee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial $Y00.W � ��i' ' �-� ���R-��.
Conditions of',�tpprovaURcasons for Disapproval ��-+�n{-----�"
L.I' �S i��!( ���.�` `}
q� � ,.
��`�0 � ^ ��=J L/�=J.�__`�J ��
,ir ���' IDate � � I�1 � �3 �
���-�� 1 0 2023 r '
GS l� �-� cnk# �o�s
JUL �)
� `�^ `t��`�'�"1�._____,_.,___._s�__.__. . SAWYER COU�i`:'
� �, ZQNING ADM{NISTRti�tO�v
Attach ro complete plans for the system and submit to the County only on paper not less than 8 1/2 x ll inches in size J��
NO R�FUND�►qFTER
s�ll-6s9s�a.o3i2z> l�3UE pF PE�N1T'
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(s):Susan Schaefer Phone: - -
Owner Address:2852 3rd st Eau Claire,Wi Z�P;54702
Project Address: 7964N John Erickson Ave
Govt.Lot: 1/4 of 1/4,Section30 T40 N-R08 E❑or W❑✓
Township:Bass Lake County:Sawyer
Project Parcel ID#:002-157-16-0400
Designer Information
Designer Name:Dylan Schultz Phone:��5 _558 _5904
Designer Address:16880W Metcalf RD,Stone Lake,WI ZiP;54876
E-mail:dylanschultzl8@gmaiLcom � _
License Number:1516129
Remarks:
Signature: Date:s�2si2o23
Origi I si naNre qu d on ea nlfiiitted copy.
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Dylan Schuf� 3 c�-�,cf
7076N Stone Lake Rd ,
Stone Lake, WI 54876 � •b 56��St S�S��e�• Q3�S
MPRS 1516129
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Sep6c ank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA !�%�st�
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s)
3-ft Trench (down-sizing credit) 7��
gal gal gal gal
Effluent Filter Manufacturec
�el� /.��
� �Z�
Effluent Filter Model#:
min.12"
(rypicap
SOIL COVER
iz
min.Vencn
depih
cyP��o • TYPICAL TRENCH
a CROSS SECTION VIEW
�-- 34"
��,P;�,� � (No Scale)
�� • •� ' • �S: Provide minimum 3 ft
System Elevation = G Z ^ �ft separation between lrenches.
(typical)
Quick4 Standard-W
w/EndCap OhservalionPipe TYPICALTRENCH
(typicaq (Show location of inlet/ outlet pipe connection on plan view.) Pvv��9
InstallpermanufacNrefs pLAN VIEW
inslmctions. �NO .SCB�@�
IR9l14/SQ4A�RIT��R����' - �� - �� �1�GRC<w1�1,1 �
v n= s.on
o � * .. d .
I v�.a„ , -. „ �� :. � (ryPical) �
LfrYYyosaa�aYYYif�i' - - - - �� _ - - - - - - �� — _ - - ��a�. �c.,xr J �
I B = � �' rt —�; m
(rypical) Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: �r�td by��ti�tratorsysterns,��o.) �
Install pursuan[to manufacturers instmctions.
l Quick4 Std-W @ 20 fl� EISA/chamber= � 6 ft' �
+ � Pairs of end caps @ 6 ft�EISA/pair= � ft'
= Proposed EISA per trench = 2�O� ft' Required Infiltration Area= S�� ft� Distribution Method:
x 2 trenches = Proposed Total EISA = S3 � n' ����% � J
PAGE40F4
In-ground Gravity Management Pian
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, ail inspection and maintenance activities shall be pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52(3), Wisc. Admin. Code.
Maxfmum Disaersal Area Oneratina Limits:
Design Flow= 3 v� gpd; BODS <_ 220 mgL"'; TSS <_ 150 mgL''; FOG <_30 mgL"'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age ot system
o nuisance factors (i.e. odors, user complaints, eta)
o mechanical malfunction (i.e., pumps, valves, switches, floats, efc.)
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 e�ent of ponding in distribution cell prior to dosing
o dosing irtegularities-if applicabie(i.e., pump re-cyciing, float switch settings, etc.)
o elecVical 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
Malnte�ance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o S�tic and dose tank(s)shall be pumped by a certified septage servicing operator licensed under s. 281.a8 Wis.
Stats.when the volume of soNds in the tank(s)exceeds on�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 whe� necessary to remove any
accumulated solids according to manufacturer's specifications. A serviang period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit tn accordance with
SPS 383.55 Wisc. Admin. Code. Report any component fallure or malfunctlon to:
Dylan Schultz 715-558-5904
Name of individual or company: Phone:
Sawyer county zoning 715-634-8288
Local government unit: Phone:
10610 Main Street, Hayward, WI 54843
Local government unit address: ZIP:
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 363.51 (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.
Continaencv 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.
" "'-"-, `�;, PRIVATE ONSITE WASTE TREATMENT county
������5 �� SYSTEMS SaWyer
��,� � �es ��, ( POWTS)
`��_ ,,�
ry` �- �i,
��'� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 -- �� �
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: � � ❑City ❑ Village [�'Town of: State Plan Transaction ID#:
��SG v� SG a �s5 I�,(,c� �---
Insp BM Elev: BM Description: Parcel Tax No:
(oo.o � /va;� �-s,�,�io� �', o�w�fi.3.�., i�f`�� o�� �tS1��6-b�oo
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic wie�— ��j Benchmark �c�p,o�
Dosing
Aeration Bidg. Sewer �
Holding St/Ht Inlet QS q '
TANK SETBACK INFORMATION St I Ht outlet y�r 6 '
TANK TO P/L WELL BLDG VENTTO ROAD Dt inlet
AIR INTAKE
Septic �+-,s� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man. �'jS o �
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative t
Surface `�`��v
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORM TION
DIMENSIONS W 3 � S �.. #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav �( Conv ❑ Aggregate ��'1 ,
INFORMATION P/L Bldg Well Waters Q GP d� Chamber Model Number:
❑ EZFIow
CELL TO fi's N N N ❑ Mound o Other �7�
DISTRIBUTION SYSTEM X Pressure Systems Oniy
Header/Manifold �Distribution Pipe(s) - jl X Hole Size ' X Hole Observation Pipes�
Length Dia Length Dia Spac Spacing ❑Yes ❑ No
SOIL COVER
Depth Over Depth Over � Depth of Seeded I Sodded Mulched
Cell Center �ell Edges � Topsoil _ _ _� ❑Yes ❑ No ❑Yes ❑ N�
COMMENTS: (Inciude code tliscrepancies, persons present, etc.)
���11.�Q � (3 rl �-3
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Plan revision required?❑ Yes❑ No ���� j( '�� � ' �� � /�
�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS AND SKETCH
SANITAAY PEAMIT NUMBER: vZ3 —I YL_
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