HomeMy WebLinkAbout008-937-17-5311-SAN-2023-151 :;;.�-, IndustrV Services Division Counry l/!
= 4822 Madison Yazds Way �C(G_i P f2 �
-`'���=r = Madison,WI 53705 saniury Prnnd Numb <to be filled in by< �
•; = P.O.F3ox 7302
�%;;;._ � Madisoq WI 5302 f.J� �(v�� �
- - J�
Sanitary Permit Application State Trana ction Number
In accordance wi�h SPS 3R3.2I(2).Wvs.Adm Code,aubrttission uf this fimm to tt�e appropriete govemmental unit V� .
is required prior to obtainuig a sanitary penuit.Nou:,appliwtion lurms for atata-owned POW1S arc submiried to P ject Address(if diff ent thnn mailing a� —
the Department of Sufetv and Prof�ssional Smices.Personal ini2mnazio�yoa prvvidz may be used for secondary 3�� � ,s �r St7� �HeC� ✓J�Q
in accurdance with ihe 1'rivac Law s.15.04 I m Slats.
L A�lication Information—Please Print All Informatiun ,Q,i'c�wa e �
e�� eny o��:*��„z � r��e�n
�i� J, f v' /�. COrs �oF3.c 7• 7s3/
Property O�mer's Mailing Address Property L«:ation �
�� � � � � � Cmvt�l.ot 3
City,State Zip Code Phax Number
l��C��e 2 � �ODsd �is-7o�- �6vB ScJ �Sr� ,,;,s��o„ l7
II.Type of Build g(check all[hat apply) �t a� 3 J
�7 T N A C1 F. W
�1 or 2 Family Dwelling-Number of Bedrooms OC Subdivuion Nama
❑PublidCommercial-Describe Uae ��0��
❑City of
❑Stete Ownrd-Ikscribe Use
CSM Number ❑Village of
i6�77 @�Townof L`cl n f<'I�
c� yo y I —
III.Type of POWTS Permit:(Check either"New"o�"ReplacemenP and ot6er applicable on ltne A Check one lax on Iiee B.Complete line C if
s licable.
A� �New Syatero ❑Replacement System ��(kLer Modificati�to Esisting Syslem(expinin) ❑Additionai P`etrratmeut[imt(eaplain)
B. ❑Holding 7:mk �m-em� ❑�v-c�ae ❑Ma,�e ❑mdc�ta�„�s�e�D��� ❑cw,�Trrz cew���
(comznflannt)
C� ❑Renewal F3ef re ❑Revision ❑Change of Plumber ❑'Crensfer to New �°1O�P��t Numfier a�al Date IssueA
Expiration Owner
IV.Dis ersal/Treatmen[Area and Taek Information:
Design Flow(gpd) Design Soii Application Rete(gpd/s� Dispersal Area Requved(s� Dispersal Area Proposed(s� System Elevatio�
3a� � y� ysa 9ss-
CapaciTy in To�al N of Manufecturer y� �� - � .�
Tank Infalmation Gallons Gallons Units y U �;
New Taoka F cis[ing Tank� � �� � p"
� 4
0
olding Tank �j Cq�� �-� �C10 1 �''�l C N't'f' �-�+c
O
Dosing Chember .._ �- �
�V.Res naibill Ststement-I,the m�derel�ed,ase� reaPa�i611HY "ot We Po ehown on t6e attached plma.
PI er's Name(Rriut) / ) Plu s ignature � MPMIPRS Numba BLL91fIG44 Phone Number
I �l�Ps(,� a�.�6335 7�5- 7Io- �7i8
Ptumber's Address(Street,CiTy.State,Zip Cade)
�P� � l s� S�- -Sa� �c�' S� ��
VL Co n /De artment Uae Onl
Permit Fee Dale Issued Issuing Agent Signamre
� ❑Disapproved a -
G/v�� )+��`�I�)_j -�r��i:.LCKI��Y�+l�l^.�,.<;�
❑Owner Givrn Reuon for Denial (
Conditions of Approval/Reasons for Disapprovet �j�f r""�,�,
��, - , ���,.�a3_____ ��,� �,� `/ ��'�',U
����'14ir-o► '�'K# 3c�.sa -.,,_ JUL 14 2023
r--� �tcpt# a'cl
Cc 1 '1 '�_,)�q �_,_,._ _ SAWYER COUNTY
> f� C
ZONING ADMINISTfiAT10^J
Amch�n complete plans P tl�e�ystem and submit to the Counry only on paper not la��hen 6 uT:I l Inchn fn+I:e �y-��I
NO R�FUN�B AF7ER �D/
SBD-6398(R 02/22) ISSUE OF PERMI�T
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
CaRS�
Owner Name(s): ,P�� l,a�� � ` �a ^o ( !/� , C�rs � Phone: 8�_- 7a.� - �6 y 8
Owner Address: �7//9 i,�l l�l% lle r R�. �c �-9Q ti a y ��, Zip; 54848
ProjectAPddress: /33 :7 N Sc � r + B� a� � P�' (3'.�� L �.� � �d' LJ�'
Govt. Lof:n+3 S'tcJ 1!4 of S � 1/4, Section�Z, T 3�N-R�E ❑ or W �
Township: �c� w� �f'e County: S`G�Yer
Project Parcel ID #: D D 89 3 � / >S 3 / /
Designer Information
Designer Name: //U ,/,'d� o� � � 1. Phone: 7/S -�- 0 7i
Designer Address: � 9 7/� �)Rs r S� S� � o,,��, � CcJ,� Zip: Sy �'7d
E-mail: �^- -� to � PJ h C� V2l9 �' [N7Cr '� . C o � Chis space reserved for appro��al stamp.
License Number: �F ?6 3 3 5�
Remarks:
� �_��':cl�'�y: �--���:1fi� ?irQ%.
�II not be created
. �essory structures
Signature: ' ? % � Date: i� ��'
Onginal signature requ red on each submitte copy.
�
CHECK BOX AS APPLICABLE. CHECK BOX A6 APPLICIIBLE
� SOIL EVALUATION o �� '� 40' � � � SYSTEM PAGE 2 OF
SITE MAP ' PL4T PLAN
PROJECT NAME . 10s pE31GN FIOW: y.�D ��
D I� S v Attach des(�n tlow oetculallons for commsrd�l plans.
PRb.IECT AOORE� S� :r Q �cp,;.�^ p�'. N Pipe IN�bad� /ASTM $ter}detd (TadEs 384.30�3�364.50-5)
/G D . O Ser�ery sewer. ''' s� G,I �/J � V ' s d�t �s'
BM Symbd: � BM Bevadon: �T Forex Mdn• � � / ��
p .. .� '
BM DescApborc ID O�f r� �r. �3��. - - •, ,' a r•/ S'� r�r� " .
� ���p�n�yy 1MPORTANT;
���(�) �� we11 Symbd (If appMcabler p «d�np�an �� 3how ground elevetion contours at s�table irttervals.
_ �— PU.T, S. 3 �� '�� ��L �--- % ._____�_ .� � __---_. --- --._
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,: �abitabf� Living are� �
shall not be created
-,.t' � �
�u jn accessory structure� P�nP�sF� ,, o �o ;
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Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSALAREA Nu��c«�- .�H�,
Uniform Elevation �renches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s):
3-ft Trench (down-sizing credit) 0� �, gal 98� gal
Eftluent Fllter Marwfacturec
Dk'E<�/LO
I Effluent Filter Motlel#: __.�r b ' /L!� E
m.ir
SOIL COVER (Np��l�
tt•
min.trenCh
�nv°�o • TYPICAL TRENCH
".a •. CROSS SECTION VIEW
f"«YP�� ^ . (No Scale)
Provide minimum 3 ft
System Elevation=�_Sft separation belween trenches.
(rypical)
Quick4 Standard-W
w/End Cap Observatlon Plpe
(typicap (Show location of inlet I outlet pipe connection on plan view.) (avi�q TYPICAL TRENCH
InsfallparmanuFacturefs PLAN VIEW
Instructions.
(No Scale)
� --- 1 —�f--------��--------- —� 1
�.�., �; . .. . . A=3.OR
�--�---------- (b7�caq �
��--------��----- -----� �
� a= � ft I m
(typical) puick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) �
(mfd by Infiltretor Sys�ems,lnc.) T
InsfallpursuanitomanuPacWrefsinsWctions. �
�Quick4 Std-W @ 20 ft EISA/chamber= �.7 b ft�
+ � Pairs of end caps @ 6 ft�EISA/pair= ��ft'
=Proposed EISA per french= �ft' Required Infiltration Area= y�� ft' DistribUtion MethOd:
x �trenches=Proposed Total EISA= �(_�ft' l'l�ac�,�'•
�
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this In-ground grevity system shall be responsfble for its psrpetual operation snd maintenance pursuent to
requirementa of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc. Admin. Code,this system shall
be considered a human health hezard if not mainteined in accordance with this approved managamsnt pian.
Furthermore, all inspection and me(ntenance actWities shall be performed by a roglstered POWTS Maintalner in
accordence with SPS 383.52 (3),Wisc.Admin. Code.
Maxtmum Disoersal Area Oaeratina Limits:
Design Flow c 30 ll gpd; BODa 5 220 mgL^; TSS 5150 mgL''; FOG 5 30 mgL''
Insoectlon Checkllst INSPECT EVERY 3 YEARS
o type Of u&8
o age of system
o nuisance fadors(l.e. odors, user complefnts, etc.)
o mechenical maltunction (t.e., pumps, valves, switches,floats, etc:)
o material fetlgue (l.e., teeks, bresks, corrosian, etc.)
o solida volume in anaerob(c treatmerrt tank(s) and any distribution appurtenence(s) ((.e.,distributlon/drop boxes)
o neglect or improper use (l.e.,exceeding design capacitles, prahibited activi6es, etc.)
o exterd af ponding in disMbuHon cell prior to dosing
o dosing ircegularitles- if epplicable(i.e., pump re-cycling,float switch settings, etc.)
o electrical �mponents- if applicable (i.e.,wiring, connections, switches, controls, tlmers, alarms, etc.)
o diatribudon laterel or laterat orifice piugging (measure laterel distal pressure-compare to design speciflcation)
o surface discharge of effiuent or sewage back-up irdo structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Saotic and dosa tank(sl shail be pumped by a certifled septage servicing operator licensad under s. 281.48 W is.
Stats. when d►e volume ot solids in tl�e tank(s)exceeds one-third(1/3}the Ilquid voluma of the tank(s)or
as required by Iocal orcJinance. Disp�sl of contents shell be pursuartt to IdR 113,Wisc.Admin.Code.
o Effluent filter(s1 shalf be inspected every 3 years end shall be cleened wh� necessary to remove eny
axumulated solids sccording to manufactureYs apecificatlons. A servfcing perlod wili alweys be greater thsn 12
months.
8ystem malntennnce reports ahall be submitted to the proper local govemment unit in accordance wRh
8P8 383.55 W(se.Admin. Code. Report amr component feilure or maHunction to:
Name of individuel or company: I� p �✓ �6L�/ Se�di�� PS�- Phone: ��S ` �3y - 7? 6 7
Locai government uNr .�a .��r� �o, ��n H� �� Phone: 7/S-- � 3`J � S'�2 &'�'
Localgovemmentunitaddress: /d6/0 i21a%n Sf Flqy"W4r� (r>� ZIP: .5y8ys
Any defective part of this syatem shell be repaired, replaced,or removed pursuarrt to SPS 383.51 (1),Wisc.Admfn. •
Code. Repair or replacement of feiled or malfunctioning components shall comply with SPS 383,Wisc.Admin. Code.
No product for chemical or phyaical restoratlon of the POWTS may be usad unless approved by the department in
acxordance with SPS 384,Wisc.Admin. Code.
Continaencv Pian
In the event thet any falled treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the approprlate agency for review snd epproval. A failed In-ground dispersel component may be
ebandoned snd replaced by a cflde-complying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued, ft shall be abandoned In accor+dance with SP3 383.33, Wisc. Admin. Code.
� "`"'' ,; PRIVATE ONSITE WASTE TREATMENT County
�'�o�$ � SYSTEMS
�;���� �s ( POWTS) Sa.Wyer
��`�'� ���,��� INSPECTION REPORT sanitary Permit tvo:
_,.,,,�,,,.>,
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 r— ���
Personal infonnation you provide may b�used for secondary purposes[Privacy Law,s. 15.04(l)(m)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
�,-�,�,� ,-�\ .-_
��
Insp BM Elev: BM Description: Parcel Tax No:
l0 O.�� (�c-�w• a�S S��l�� �� S� Oo� 'Q�-- 1'� — S3 l �
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � '�� Benchmark dp ��
Dosing
Aeration Bidg. Sewer 9'?•a
Holding St/Ht Inlet Q'),o '
TANK SETBACK INFORMATION St I Ht Outlet 46.�
TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet
AIR INTAKE
Septic �S� �j�` 1'7� -t-tT NA DtBottom
Dosing NA Installation
Contour
Aeration NA Header I Man. �
6•.S'
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface 9 S�,s
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO ATION
DIMENSIONS W 3 L L�t� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �
INFORMATION P/L Bldg Well Waters � IGP p� Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO t-�� h-o1.s- �i-7p �,/ o Mound o Other
-- —
- —_- — ------- ----x'�-----
DISTRIBUTION SYSTEM X Pressure Systems Only
-
Header/Manifold Distribution Pipe(s) � 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 � Cell Etlges � Topsoil _� ❑Yes ❑ No � ❑Yes ❑ No l
COMMENTS: (Include code discrepancies, persons present,etc.)
������i ������3
r �
Plan revision required?❑Yes❑ No I E,3 � � 2c�II � � �� Gc� � /� �
�! ��
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710{R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBEA: �-_,���s�_
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